BIOETHICS AND

ITS
APPLICATION
ISSUES ON:
NRG 109 WEEK V
CONTRACEPTION
CONTRACEPTION
◦ Abstinence
◦ Withdrawal of the penis before Ejaculation (coitus
interruptus)
◦ Fertility awareness
◦ Mechanical barriers:
◦ vaginal diaphragm, vaginal ring, cervical cap, condom
◦ Chemical barriers:
◦ insertion of spermicidal foams, creams, jellies, or
suppositories into the vagina before intercourse.
CONTRACEPTION
◦ Intrauterine devices (IUDs)
◦ Hormonal:
◦ oral contraceptives (birth control pills), subdermal implants
of synthetic progestin, transdermal patches
◦ Emergency contraception: hormonal: levonorgestrel
pill
◦ Surgical sterilization: tubal ligation and vasectomy
ISSUES ON
CONTRACEPTION
CONTRACEPTIO
N
◦ The main argument against the use of contraception
is based on the natural law theory
◦ Cancer cells, sperm, and ova all have a human genetic
code, and on the least restrictive definition of genetic
humanity, such cells would have a right to life, implying that
if abortion is impermissible, then so is contraception and
chemotherapy

Encyclopedia of Applied Ethics.

2012 Elsevier Inc.
 AUTONOMY vs. HUMAN
DIGNITY
Ethical questions:
• to express respect for autonomy in ways that are
less conflicting with human dignity, which is
preferable to forcing people to act against their
preferences;
• expanding education about contraception, thereby
reducing the situations in which abortion may be
considered and chosen.
Would you rather use contraception
than unwanted pregnancy? Encyclopedia of Applied Ethics.
2012 Elsevier Inc.
UTILITARIAN view
◦ is that patients possess rights to
contraceptive treatment to reduce
unplanned pregnancy and their resort
to abortion
FEMINISTS’ ETHICS view
◦ emphasize that unless a woman can
control her reproductive capacities,
she will not be able to pursue her
personal and professional interests as
well as a man can.
IS IT ETHICAL FOR THE
NURSE TO PRESCRIBE
CONTACEPTION?
Responsible Parenthood and Reproductive Health
Act of 2012

“access to family planning

devices such as contraceptives
and sterilization”
ABORTION
ABORTION
◦ defined as the premature termination of a
pregnancy resulting in the death of the
embryo or fetus, it is generally
understood to refer to the deliberate
termination of an unwanted pregnancy.
◦ it is distinguished from miscarriage
Encyclopedia of Applied Ethics.
2012 Elsevier Inc.
ABORTION
◦ sometimes described as the
intentional termination of a pregnancy.
◦ is the termination of a pregnancy
before the infant can survive outside
the uterus.
Britanica)
ABORTION TERMS:
ELECTIVE ABORTION:
◦ is the interruption of a pregnancy before the 20th week of
gestation at the woman’s request for reasons other than
maternal health or fetal disease.
THERAPEUTIC ABORTION:
◦ is the interruption of a pregnancy before the 20th week of
gestation because it endangers the mother’s life or health or
because the baby presumably would not be normal.
Encyclopedia of Applied Ethics.
2012 Elsevier Inc.
ABORTION TERMS:
spontaneous abortions/miscarriage:
◦ the expulsion of the products of conception before the 20th
week of gestation without deliberate interference

viability:
◦ refers to the point at which the fetus is able to survive
independently of the mother

Encyclopedia of Applied Ethics.

2012 Elsevier Inc.
Revised Penal Code of the
Philippines
◦ abortion has been banned entirely for
over a century
◦ mandate imprisonment for women
who undergo abortion, as well as for
any person who assists in the
procedure
 MORAL
ARGUMENT
ABORTION
◦ The debate on abortion focuses on the
moral status of the fetus.
◦ The fetus either does or does not
have a right to life that may or may
not override any competing rights of
the mother.
ABORTION
◦ Although in all human cultures people
have valued, loved, and protected
their children and this care has been
recognized as one of the most basic of
ethical responsibilities
ABORTION
◦ When does human life begin?
◦ Is direct abortion a deliberate killing of
a living human?
◦ Rights of the Unborn Child?
◦ A Woman's Right to Decide?
Judith Jarvis Thomson
◦ the implication that abortion is permissible in some cases but
not in others.
◦ Thomson argues that the right to life does not always
outweigh the right to decide what happens in and to one’s
own body or, more generally, that the right to life is not a
right to whatever one happens to need to go on living.
◦ the fetus only has the right to the use of its mother’s body if
the woman has given it that right, and at least in some
cases of pregnancy – for example, those that are the result
of rape or failed contraception – the woman has not given
it that right.
There are various reasons why abortion
might be considered:
◦ the woman is herself virtually a child
◦ the woman already has more children than she can manage
◦ having a child at this time will interfere with a career
◦ having a child at this time will involve loss of earnings
◦ the woman is a rape victim
◦ the woman is a sexually abused eleven-year-old
◦ the woman has already had three children by Caesarian section
◦ the woman was deserted by her partner when he learned of the pregnancy
◦ the woman is severely mentally defective
◦ the woman is homeless
◦ the fetus is believed to be defective
◦ the woman's life or health is seriously threatened.
 ARE ANY
REASONS FOR
ABORTION GOOD
ENOUGH?
 ARTIFICIAL
INSEMINATION
Artificial Insemination:
◦ The oldest, well established procedure in cases
of untreatable male infertility which has been
regulated and submitted to standard medical
guidelines in most developed countries
TERMS:
AIh:
◦ When the husband's semen is used
◦ homologous or from the husband

AID:
◦ Artificial Insemination by Donor
◦ Donor’s sperm is used
Encyclopedia of Applied Ethics.
2012 Elsevier Inc.
sperm source:
Anonymous & non-anonymous sperm donations
◦ Practice of non-anonymous sperm donation is becoming
popular because many donor-conceived persons have a
desire and interest in finding out about where they came
from
◦ donor sperm should not be used before fertilization
attempts with the husband’s sperm have failed following
application of micromanipulation methods.
ISSUES?
Artificial insemination by donor (Aid) :
◦ an attempt to reproduce while simultaneously
rendering reproduction not an act of personal
union but a technological procedure.
◦ solutions that violate the most fundamental human
relationships.
◦ artificial insemination ignored not only the moral
integrity of the couple, but the rights of the child
◦ Fundamental to the well-being of any human
person is the person's own sense of identity
AIH:
◦ theologians have argued for the morality of AIH,
since they regard it simply as an assistance of nature
◦ But since the natural marital act is not performed and
hence is not the cause of fertilization, AIH violates
the principle of inseparability and has been explicitly
rejected by the Church
Principle of inseparability:
The principle of the inseparability of the unitive
and procreative meanings of sexuality demands
that:
a. the procreative purpose of the sexual act not be
deliberately destroyed so as to render a
naturally fertile act sterile;
b. that the procreative purpose of the sexual act
not be achieved in isolation from the unitive
expression of the couple's love
AId:
◦ a more radical erosion of the natural bond between
parent and child than AIH because it also involves a
violation of the nontransferable and inalienable rights
to procreation that married partners give one
another.
◦ does not justify her obtaining a child by an act of
adultery
◦ semen donor himself is being sexually exploited like
a prostitute
 IN-VITRO
FERTILIZATION AND
SEX SELECTION
in vitro fertilization (IVF):
◦ a process whereby egg cells are fertilized by
sperm outside the womb.
◦ involves removing a ripe egg from a woman
and in a glass (in vitro) mixing it with some
semen so that fertilization takes place
◦ the resulting embryo is then transferred to
a woman's uterus where it is hoped it will
implant and subsequently develop.
◦ a
what situations might IVF be used?
◦ if tubal surgery has not corrected a previous
difficulty with the fallopian tubes, IVF allows the
possibility of overcoming this problem by bypassing
the tubes
◦ if a woman cannot produce an egg, an egg or eggs
could be donated by a donor
◦ if both partners are infertile, eggs and semen could
be donated
in vitro fertilization (IVF):
◦ a deviation from natural reproduction
◦ UK became the first country to allow so-called three-
person IVF for women with mitochondrial disease.
The technique allows healthy mitochondria from a
woman donor to be combined with the DNA of the
parents.
TERMS:
Ectogenesis:
◦ The creation and gestation of a human baby outside the maternal
womb
Embryo:
◦ A term for the developing human being during the first 8 weeks
after fertilization
In vitro:
◦ Outside the human uterus
Encyclopedia of Applied Ethics.
2012 Elsevier Inc.
Sex selection:

◦ giving people the freedom to choose their

children in this way could lead to further
ethical problems
 SURROGATE
MOTHERHOOD
surrogate motherhood
◦ The bearing of a child by a woman with the aim of turning
it over to another woman
◦ The embryo may have been conceived by the surrogate
mother and a man (usually the partner of the woman who
is to receive the child after birth) either by sexual
intercourse or by artificial insemination, or it may have
been conceived in vitro and transferred to the womb of
the surrogate mother, who then carries the pregnancy to
its termination.
surrogate mother

◦ a woman who gives birth after carrying the fertilized

ovum of another woman or, more commonly, after
being artificially inseminated with sperm from the
biological father.
Surrogacy:

◦ thought to be a 'treatment' option for the infertile

◦ an alternative to adoption
◦ fulfill peoples desires to be parents
Problems & issues:
◦ Question of morality
◦ concern about surrogate mother hood involves the true nature of mothering
◦ Payment
◦ raises an ethical question around whether surrogacy is different from other kinds
of paid work
◦ Exploitation
◦ The infertile couple and the surrogate mother are highly vulnerable to
exploitation.
◦ “Womb renting”
◦ Surrogate motherhood vs. conventional motherhood
◦ Is “motherhood” merely the biological act of bearing children?
◦ Conflict of rights
◦ dispute revolves around who has the strongest claim to the child
 STEM CELL
TECHNOLOGY
Stem cell technology
◦ a rapidly developing field that combines the efforts of
cell biologists, geneticists, and clinicians and offers
hope of effective treatment for a variety of malignant
and non-malignant diseases.
◦ predominant methods being used to derive or attempt
to derive human embryonic stem cells require
destruction of the embryo
Stem cell technology
◦ a rapidly developing field that combines the efforts of
cell biologists, geneticists, and clinicians and offers
hope of effective treatment for a variety of malignant
and non-malignant diseases.
◦ predominant methods being used to derive or attempt
to derive human embryonic stem cells require
destruction of the embryo
Issues and concerns in Stem cell
technology
◦ Embryo destruction
◦ Oocyte harvesting
◦ raises concerns related to safety of the donor
◦ issues relate to informed consent of both donors of
gametes and embryos as well as recipients of stem cells
and stem cell products
◦ concern related to the commercialization of the process,
justice, and the responsible conduct of research
RAPE
rape
◦ is the crime of forcing somebody to have sex with one
especially with violence.
◦ It is the crime of forcefully having sex with someone
against the person's wish (Chiedu, 2012).
◦ is an act of sexual violence that involves intercourse
without consent or against someone being willing to
engage in the act (Brigneti and Egbonimali, 2002).
Satutory rape

◦ Sexual intercourse with a person below

the age of consent.
Effects of rape
◦ Physical trauma, possible infection, possible
pregnancy
◦ has long-term health consequences for survivors both
psychologically and physiologically.
◦ social stigma associated with rape
◦ survivors frequently experience depression, anxiety,
PTSD, sense of diminished self-worth and negative
sexuality issues.
Issues:
◦ Violation of basic human rights
◦ Violation of personhood
◦ Violation of sexuality as an expression of mutual love for
the sexual act to be performed
◦ prevention of pregnancy raises special ethical problems
◦ Ethical problems arise in the treatment of rape victims
when methods are proposed that probably prevent
conception but that may be abortifacient if conception
has taken place
Care of victims:
1. To offer the psychological support and counseling
2. To provide medical care for injuries
3. gather evidence to be used if the rapist is
apprehended and prosecuted.
4. To provide treatment to prevent possible venereal
disease and pregnancy.
End of
life
issues:
SUICIDE
suicide
◦ ending ones life
◦ An act, whether of commission or omission, and
whether performed by himself or others, by which an
individual autonomously intends to bring about his
death because he wishes to be dead, either in order
to avoid a life he does not wish to live or as a means
to achieving some other purpose.
Gestured suicide
◦ A feigned act of suicide (which may, but need not,
involve self-harm), at the end of which the protagonist
wishes, intends, and expects to be alive.
Suicide conservative

◦ person who believes that in general we should

intervene in the suicidal acts of others because
suicide can never be in a person’s best interests
and/or because it is morally wrong.
Suicide liberal
◦ person who believes that in general we should not
intervene in the suicidal acts of others because
autonomy is centrally important in the life of persons,
and thus we each have the right to do what we will
with our lives, even if we wish to give them up.
Morality of suicide:
◦ Is suicide justifiable?
◦ Can the principle of autonomy be applied?
◦ morally wrong because it involves killing.
◦ moral discussions of suicide center on the significance
of the Principle of The Sanctity of Life
◦ a principle of implied protection regarding aspects of
sentient life that are said to be holy, sacred, or
otherwise of such value that they are not to be
violated
◦ concept denotes the absolute value of human life
Morality of suicide:

◦ can suicide be permissible depending on the intent?

◦ Which other principle do you think opposes suicide?
 ADVANCE
DIRECTIVES
Advance Directives:
◦ a general term that refers to documents that “formally
convey an individual’s wishes about medical
decisions to be made in the event that he or she
loses decision–making capacity”
◦ Meant to ease anxieties and moral distress from
difficult decisions about which care to use and when
to initiate or stop advanced medical treatment
Types of Advance Directives:
◦ The living will
◦ a legal document used to state certain future health care decisions only when a person
becomes unable to make the decisions and choices on their own
◦ only used at the end of life if a person is terminally ill (can't be cured) or permanently
unconscious.
◦ Durable power of attorney for health care/Medical power of attorney (DPOA-HC)
◦ a legal document in which you name a person to be a proxy (agent) to make all your health
care decisions if you become unable to do so.

◦ Physician Orders for Life-Sustaining Treatment

◦ A POLST form also helps describe your wishes for health care (not an advance directive)
◦ Do not resuscitate (DNR) orders
◦ medical staff will try to re-start your heart and breathing using methods such as CPR
(cardiopulmonary resuscitation) and AED (automated external defibrillator).
◦ To be legally valid, a living will must comply with state
law requirements such as those regarding how the
document is signed and witnessed or what must be
included in the text of the document.
◦ But what if there are no existing laws?
◦ Philippines doesn’t have a law on Advance
directives
Limitations and issues of living wills &
dpoa-hc:
◦ Address only a narrow range of end-of-life decisions
◦ they cannot realistically anticipate all the serious medical circumstances
the person may face in the future, and the written document may not be
available at the time and place needed.
◦ Preferences often change as they develop a progressive illness
or as their values or priorities change over time.
◦ When DPOA-HC have joint appointments can create conflicts
and complications
◦ autonomy gives patients’ a right to control their treatment
according to their preferences
◦ Individual self-determination and best interest
DNR
Do not resuscitate (dnr):
◦ is a medical order written by a doctor where it instructs
health care providers not to do cardiopulmonary
resuscitation (CPR) if a patient's breathing stops or if the
patient's heart stops beating.
◦ DNR order is generally written when the client or proxy
has expressed the wish for no resuscitation in the event
of a respiratory or cardiac arrest
◦ sometimes referred to as passive euthanasia
Do not resuscitate (dnr):
◦ created, or set up, before an emergency occurs
◦ allows you to choose whether or not you want CPR in
an emergency
◦ It does not have instructions for other treatments,
such as pain medicine, other medicines, or nutrition.
◦ may be a part of a hospice care plan
Some Issues on dnr:
◦ DNR discussions are delayed until it is too late for the patients to
participate in decisions regarding resuscitation.
◦ Physicians do not provide adequate information to allow patients to
make informed decisions
◦ Physicians inappropriately estimate the value of DNR orders to limit
other treatments
◦ Issues for those relying on religion as the main source for their moral
and ethical codes.
◦ DNR was construed as either the patient was not worth to saving his/
her life or the family did not care enough to save the patient's life.
Nurse’s responsibilities -Do not
resuscitate (dnr):
• Clinical nurses actively participate in timely and frequent discussions on
changing goals of care and initiate DNR discussions with patients and their
families and significant others.
• Clinical nurses ensure that DNR orders are clearly documented, reviewed,
and updated periodically to reflect changes in the patient’s condition.
• nurses ensure that, whenever possible, the DNR decision is a subject of
explicit discussion between the health care team, patient, and family (or
designated surrogate), and that actions taken are in accordance with the
patient’s wishes.
• nurses facilitate and participate in interdisciplinary mechanisms for the
resolution of disputes among patients, families, and clinicians’ DNR orders.
EUTHANASIA AND
ASSISTED SUICIDE
Euthanasia
◦ also known as mercy killing, and assisted suicide
◦ Deliberately bringing about the death of a person
who’s suffering from an incurable disease or
condition, either actively or passively
Euthanasia – PRO
◦ Beneficence: should allow people to die in dignity and
without pain
◦ Rights-based argument: our bodies are our own, and
we should be allowed to do what we want with them
Euthanasia – CONS
◦ The sanctity of life: life is given by God, and only God should decide when to
end it.
◦ Euthanasia as murder: principle of autonomy forbids the voluntary ending of
LIFE
◦ The role of palliative care
◦ often argued that pain and suffering experienced by patients can be
relieved by administering appropriate palliative care
◦ The rights of vulnerable patients
◦ coercion of patients receiving costly treatments to accept euthanasia
◦ The doctor-patient relationship and the physician’s role
◦ undermine the doctor-patient relationship, destroying the trust and
confidence built
◦ if euthanasia was made legal, the laws regulating it would be abused
DYSTHANASIA
Dysthanasia
◦ "difficult or painful death, used to indicate the
extension of the dying process through treatment that
only prolongs patients' biological life.
◦ Also called:
◦ Therapeutic intensification
◦ therapeutic obstinacy
◦ therapeutic fierceness
◦ futility therapy or medical futility
Dysthanasia
◦ a term generally used when a person is kept alive
artificially, in a condition where otherwise they
cannot survive

◦ It has neither quality of life nor dignity.

◦ slow and painful death without the quality of life
What’s wrong with Dysthanasia:
◦ to optimize the treatment of patients and not to waste
resources
◦ treatment stubbornness & prolong the process of
Death
◦ implies the unreasonable and ethically unacceptable
lengthening of the process of death with the help of
technology.
Dysthanasia and questions to
ponder
◦ Palliative care and respect for patients' rights are
efficient means to prevent dysthanasia
◦ But what are these right? Does it include letting
them die?
◦ Is stopping dythanasia morally ethical?
◦ If so, does it compare with passive euthanasia?
ORTHONASIA
ORTHOTHANASIA / ORTHOTANASIA
Orthonasia
◦ A normal or natural manner of death and dying
◦ correct dying, or allowing to die or letting die.
◦ Sometimes used to denote the deliberate stopping of
artificial or heroic means of maintaining life
◦ death is neither directly caused nor intended or
postponed. It merely happens.
Possibilities for Orthonasia
1. when the treatment to prolong life is useless or futile
2. when the prolongation of life or the postponement of
death is unduly burdensome in the first place for the
patient and the family
3. when the patient needs painkillers or medical
sedation, which does not intend the death of the
patient.
Orthonasia (pros)
◦ Death with dignity
◦ Less sufferings

Orthonasia (cons)
◦ Not respecting the sanctity of life
◦ Allowing patient to die
Questions to ponder:

◦ Is there any equivalence between killing and allowing

to die?
◦ Is it ethical to allow a person to die?
TERMINATION OF
LIFE-SUSTAINING
TREATMENT
Termination of Life-Sustaining
Treatment
◦ patient who has decision-making capacity appropriate
to the decision at hand has the right to decline any
medical intervention or ask that an intervention be
stopped, even when that decision is expected to lead
to his or her death and regardless of whether or not
the individual is terminally ill.
When is it justifiable to discontinue life-
sustaining treatments?
◦ If the patient has the ability to make decisions & fully
understands the consequences

◦ If the treatment no longer offers benefit to the patient

Who are qualified to refuse treatment?
And be justifiable:
◦ patients that have serious illness with limited life expectancy
(doesn’t have to be terminally ill)
• Patient must be competent
• Depends on the law of the land
◦ Patients with advance directives (for patients who are no longer
competent)
◦ With surrogate decision-maker
Nurse must ensure patient’s capacity to
make decisions:
considered intact if the patient:
▪ understands the clinical information presented
▪ appreciates his/her situation, including
consequences with treatment refusal
▪ is able to display reason in deliberating about their
choices
▪ is able to clearly communicate their choice.
 WITHDRAWING OR
WITHHOLDING FOOD
AND FLUIDS
Is it justifiable to withdraw or Withhold Food
and Fluids?
At all times, patients must be given basic humane,
compassionate care. They should be given a comfortable
bed, human contact, warmth, and be kept as free from
pain and suffering as possible.
• Is food and fluid part of basic humane care?
▪ This includes intravenous fluids, parenteral nutrition
• If options and guidelines are available, legally
▪ If (state, federal, national) laws are available to
support its legality
▪ If it’s legal, is it ethical?
Is it justifiable to withhold or withdraw care
because of costs?
◦ avoid costly treatments that offer little or no benefit,
but the obligation to the patient outweighs the
obligation to save money for health care institutions
◦ There are rare situations in which costs spent on one
terminally ill patient could be clearly better used on
another, more viable patient.
▪ To apply the ethical principle of justice
END