CONDITIONS FOR ETHICAL DECISION MAKING

ABORTION
Is the termination of pregnancy by the removal or expulsion of an

embryo or fetus from the uterus, resulting in or caused by its death.

ABORTION
It is a method of birth control in which

conception is terminated rather than prevented.

In Ancient Greece, Plato and Aristotle

recommended abortion in order to avoid excess population in small Greek City states.

abortion
Expulsion of a fetus from the mothers

womb before it is viable.

Normally, a child is considered to be

viable at about the 28th week or toward the end of the 7th month (at least the fetus born during this period has about a 10% chance of survival)

Sa dalagang hindi dinadatnan,

pamparegla ang kailangan.

pamparegla sa aleng may asawa, upang hindi mabuking sa mister

nya, pagdating mula Saudi Arabia.

TYPES OF ABORTION

1. Natural abortion
Or the expulsion of the fetus through

natural or accidental causes. This is also known as SPONTANEOUS or accidental abortion. MISCARRIAGE

2. Direct or intentional abortion

Refers to the deliberately

induced expulsion of a living fetus before it has become viable

3. Therapeutic abortion
The deliberately induced

expulsion of a living fetus in order to save the mother from the danger of death brought on by pregnancy.

4. Eugenic abortion
This is recommended in cases where

certain defects are discovered in the developing fetus.

It is termed eugenic because it is

meant to get rid of abnormal babies (that is, children with birth defects and deformities)

5. Indirect abortion
In this case, the removal of the fetus

occurs as a secondary effect of a legitimate or licit action, which is the direct and primary object of the intention.

 An abortion can occur spontaneously

due to complications during pregnancy or can be induced.

Abortion as a term is most commonly referred to the induced

abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.

EUTHANASIA
Greek term thanatus- the act of practice of permitting the death of

a hopeless sick or injured individuals in a relatively painless way for reasons of mercy. It is commonly called merciful killing to relieve suffering.

euthanasia
Etymologically, euthanasia

means easy death (from the Greek word eu easy and thanatus death)

More strictly, it means painless,

peaceful death. It is popularly known as mercy killing

Cases of euthanasia may be grouped into:

SELF-ADMINISTERED OTHER-ADMINISTERED

 ACTIVE

(positive) euthanasia- in which terminally ill patient will deliberately, directly terminate his life by employing painless methods it is an act of commission insofar as it is voluntary and deliberate.
(negative) euthanasia- in which one allows oneself to die without taking any medicine or by refusing medical treatment it is an act of omission insofar as one simply refuses to take anything to sustain life.

PASSIVE

Other administered
A. active and voluntary euthanasia
Is one in which either a physician, spouse

or a friend of the patient will terminate the latters life upon the latters request. It is voluntary insofar as it is requested by the patient. It is active insofar as some positive means is used to terminate the patients life.

 B. passive and voluntary euthanasia

Is one in which a terminally ill patient is

simply allowed to die by the physician, spouse, or an immediate relative, upon the patients request. It is passive insofar as no positive method is employed. The patient is merely permitted to pass away. It is voluntary insofar as this is done upon the patients request.

 C. active and nonvoluntary euthanasia

Occurs when it is the physician, spouse,

close friend or relative who decides that the life of the terminally ill patient should be terminated. It is active insofar as some positive method is used to terminate the patients life; it is nonvoluntary insofar as the termination of the patients life is decided by an individual other than the patient.

 D. passive and nonvoluntary euthanasia

Is one in which a terminally ill patient is simply

allowed to die, as requested by immediate family members, (spouse or parents) or the attending physician. It is passive in as much as no positive means is employed to end the patients life; it is nonvoluntary insofar as other persons make the moral decision to terminate the patients life.

PRINCIPLE OF INFORMED CONSENT

Principle of informed consent

It is the right and responsibility of every competent individual to advance his or her own welfare. This right and responsibility is exercised by freely and voluntarily consenting or refusing consent to recommended medical procedures, based on a sufficient knowledge of the benefits, burdens, and risks involved.

INFORMED CONSENT
A process by which patients are informed of the possible outcomes,

alternatives, and risks of treatment and required to give their consent freely.

 In health care, INFORMED CONSENT

refers to the patients deliberate and voluntary acceptance of a health care procedure which presupposes sufficient disclosure of the nature and goal of the procedure; its possible side-effects, risks, benefits; and the available medical options.

The ability to give informed consent depends on:

1. adequate disclosure of information

2. patient freedom of choice 3. patient comprehension of

information; and 4. patient capacity for decision-making

The disclosure of information

The consent that is given by the patient is an informed one. It is the elicited act of his will which he may not be able to do so without the light of knowledge in the mind obtained from the disclosure of information.
Meaning, the patient has prior knowledge about the medical procedure, risks and benefits, and the available options for him to enable his will to make decisions resulting to the provision of his consent.

 The decision his will makes to give his

consent is limited by what his mind knows about the said information. Thus, the amount of knowledge upon which the will depends its decisionmaking to consent primarily relies on the extent of information given.

 In other words, the more information,

the more knowledge is obtained; the more knowledge is obtained, the freer the will to tend to elicit consent. The opposite happens if the amount of information given is too small or unduly insufficient.

Usual standards of adequate disclosure of information:

a. The disclosure standard based on the traditional practices of the professional community. It refers to what is generally acceptable to medical practitioners in matters of disclosing information. This can be judged by common sense among them. Ex: expected risks are told of a required procedure.

b. The reasonable standard based on what a hypothetical reasonable person would judge a pertinent to the decision-making process. Ex: a conscious patient would want to be informed about some alternative procedures before he finally makes his choices.

c. The subjective standard based on what a particular patient needs to know. Ex: a prominent patient who asks about the nature of a more scientifically advanced procedure other than what can usually be done.

By meeting these four requirements, three necessary conditions are satisfied:

1. that the individuals decision is voluntary
2. that this decision is made with an appropriate understanding of the

circumstances; and 3. that the patients choice is deliberate in so far as the patient has carefully considered all of the expected benefits, burdens, risks and reasonable alternatives.

 Legally, adequate disclosure includes

information concerning the following: A. diagnosis B. nature and purpose of treatment C. risks of treatment; and D. Treatment alternatives

The voluntary nature of informed consent

Basically, every informed consent is

voluntary in nature. It is the product of the patients decision which is within the power of his will. As a voluntary act, informed consent presupposes the use of the patients knowledge and freedom without which it cannot be voluntary thereby destroying its nature.

patients competence
Refers to the ability of the patient to make choices and decisions on the information disclosed. It may vary from one case to another under specific circumstances. It is also possible that patients competence may be impaired or completely absent because of the gravity of his pathologic condition. Consequently, he may not be able to give the necessary informed consent.

FOUR MAJOR ELEMENTS OF INFORMED CONSENT

1. COMPETENCE
This refers to a patients capacity for

decision-making.

2. disclosure
This refers to the content of what a

patient is told or informed about during the consent negotiation.

3. comprehension
This refers to whether the information

given has been understood.

4. voluntariness
This means that consent must be

voluntary. He must make a choice without being unduly pressured by anyone else.

Other forms of consent:

CONSENT BY PRESUMPTION- this is

reasonably presumed to be present in the subsequent employment and series of procedures as they are aligned with the primary procedure to which explicit consent is expressed.

 Ex: though it is not utterly expressed,

consent to perineal flushing is reasonably presumed that is done after the patient is medically assisted for delivery to which she gives explicit consent.

 Another form of consent by presumption is

attributed to the patient who, in his current biological condition, cannot utterly articulate consent. The judgment of prudence and reason takes a sufficient ground for the consent of the most appropriate medical procedure to serve the best interest of the patient.

 Ex: an almost unconscious and

unmanageable patient who is gasping and panting for breath because of severe gunshot wound is reasonably judged to be consenting to immediate oxygen inhalation, surgery, and other necessary medical intervention geared towards the sustenance of his life.

Consent by proxy
This is done when the patient is not capable

of giving informed consent and is legitimately represented by a competent surrogate who acts on his behalf. The patient may either be unconscious, insane, or a minor/child who is out of reason or not at the age of reason. The competence of the representative primarily resides in his manifested motivation to serve the best interest of the patient.

 Ex: a febrile baby is given an antipyretic

injection at the consent of his mother.

TRUTHFULNESS
Is the state or condition of being

truthful. To be truthful is to be communicative of truth in its simple and genuine character.

Moral obligations to truthfulness

As a general rule, every human person who

has the use of reason is morally obliged to be truthful and not to distort the truth. His rational faculty of intelligence that enables him to have an intrinsic desire and propensity for truth is that which negates any preference for anything contrary to being truthful.

LIE
Is the distortion and perversion of what

is in the mind, characterized by the malice of deception which causes grave harm. The presence of deception in lying implies ones lawful basis of knowing the truth to which he has a right. Hence, a lie is an untruth told to one who has a right to the truth.

 In health care practice, health professionals are

morally responsible for the truthfulness they ought to accord their patients and their patients relatives. A lie in its given definition should not be among the medical and health care standards to be observed by the health care practitioners whose profession by nature is associated with public trust and confidence.

 Is it possible to withhold the truth or

even state what seems untrue without the element of lying thereby being morally excused?

 This question has to be properly

qualified. It is also in harmony with the dictates of reason that communication of truth along with its simplicity and genuineness is couples with prudence and discretion.

prudence
Is that human quality which enables one to

have a good grasp of the most appropriate means to take so as to achieve an end in a given situation. It may be characterized by carefulness and good judgment, on one hand, and cautious response to stimuli and exactness, on the other. In short, it provides reasonable balance between falling too short or going too far.

discretion
Is a human quality of making a correct

judgment on what is right and proper to be done according to propriety and reason under certain circumstances.

Conditions for the concealment of the truth:

The truth can be concealed by mere

refusal of disclosure or by a seemingly untrue statement when one or any of the following conditions is evident:

 The inquiring person has no right to it.

Ones right to certain knowledge that can

be obtained from another through inquiry may not be in force under all circumstances. It has to be weighed down with respect to others rights. Thus, the right to knowledge may cease when it is to be employed at the destruction of the others rights.

Ex: a suspiciously looking individual inquires at the nurses

station about the location of a patient who turns out to be his target of assassination.

 The duty withhold it is greater than the duty

to reveal it. This is in place when the truth is sealed with secrecy whose exposition may cause unnecessary harm and undue damage comprising acts against justice and charity.

 Ex: a health care practitioner is legally

and morally obliged to observe professional secrecy regarding his patients health information acquired by the nature of his profession.

 There is a reason sufficiently grave

calling for the withholding of the truth. A reason is sufficiently grave when it involves higher moral principle or value that is at stake including common good, peace, etc.

 Ex: sensing that a patients relative has the

tendency to be hysterical or violent, which may cause disorder in the hospital, the attending physician withholds the unfolding of truth about the terminal condition of the patient.

Mental reservation
Refers to the ambiguous and veiled

statement to the inquirer who is not entitled to the truth for having no right to it.

 In health care, the patient, by reason of inevitable

circumstances, at least, at a certain moment, may not be able to invoke his rights to the truth about his health condition. This stems from the patients inability to bear the truthful information by reason of which he loses his right and is superseded by a greater principle that values his protection from undue harm and damage.

 Ex: a patient with terminal cancer is in danger of

death. Though aware that his condition is fatal, he does not know that he is dying soon. Despite the possibility of mental breakdown out of truthful exposition of his proximate death, the patient is politely and caringly told about it so that he may be able to prepare himself to face God by going to confession, atoning his sins, and others. He is just given the necessary medical treatment for his mental breakdown.

Professional secrecy and privacy

Since it is a revelation of what is in the mind,

truthfulness can also be considered a manifestation of ones innermost depth in his way of thinking, speaking, and acting as truthful person. Tempered with prudence and discretion, being truthful bridges all gaps, settles differences, repairs wounds and eliminates divisiveness among people for human growth in peace and harmony.

Professional secrecy
Pertains to the confidentiality and privacy of

facts about the personal and pathologic circumstances of the patient known to the health care practitioners through his submission to health care processes.

Can secrets be broken and disclosed?

Yes, provided the necessary

conditions are met:

Conditions for the breaking of professional secrecy in health care

1. The patient practically allows the

disclosure or is obliged to do so. Ex: upon realizing that he needs a wide horizon of assistance, an AIDS patient makes up his mind to permit the disclosure of his condition.

 2. the secret is exposed by others and becomes a public knowledge. In which case, it ceases to be a secret.
Ex: the information about the pre-marital pregnancy of a bachelor-woman which is supposed to be a secret spreads out because of its disclosure by others.

 3. the concealment of a secret

endangers a greater good which is of higher value. At this juncture, the secret itself ceases to be. Ex: an AIDS patient who, in his severely depressed frame of mind, escapes and threatens to infect others.

Familys right to information

By reason of the natural bondage of kinship, the immediate responsible members of the family may also have the right to information regarding their patient. Moreover, they are affected, in significant ways, by the patients illness. Any ignorance about it may give rise to unnecessary damages as in transmission of infection in case of communicable disease, and the likes.

Organ transplantation
is the moving of an organ from one body to another, or

from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of Regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the patient's own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

Types of transplant

Autograft
Transplant of tissue to the same person. Sometimes

this is done with surplus tissue, or tissue that can regenerate, or tissues more desperately needed elsewhere (examples include skin grafts, vein extraction for CABG, etc.) Sometimes an autograft is done to remove the tissue and then treat it or the person, before returning it (examples include stem cell autograft and storing blood in advance of surgery).

Allograft
An allograft is a transplant of an organ or tissue

between two genetically non-identical members of the same species. Most human tissue and organ transplants are allografts. Due to the genetic difference between the organ and the recipient, the recipient's immune system will identify the organ as foreign and attempt to destroy it, causing transplant rejection. To prevent this, the organ recipient must take immunosuppressants. This dramatically affects the entire immune system, making the body vulnerable to pathogens.

Isograft
A subset of allografts in which organs or tissues are

transplanted from a donor to a genetically identical recipient (such as an identical twin). Isografts are differentiated from other types of transplants because while they are anatomically identical to allografts, they don't trigger an immune response.

Xenograft and xenotransplantation

A transplant of organs or tissue from one species to

another. An example are porcine heart valve transplants, which are quite common and successful. Another example is attempted piscine-primate (fish to non-human primate) transplant of islet (i.e. pancreatic or insular tissue) tissue. The latter research study was intended to pave the way for potential human use, if successful. However, xenotransplantion is often an extremely dangerous type of transplant because of the increased risk of non-compatibility, rejection, and disease carried in the tissue. This is a very serious type of transplant.

Split transplants
Sometimes a deceased-donor organ, usually a liver,

may be divided between two recipients, especially an adult and a child. This is not usually a preferred option because the transplantation of a whole organ is more successful.

Domino transplants
This operation is usually performed on patients with cystic

fibrosis because both lungs need to be replaced and it is a technically easier operation to replace the heart and lungs at the same time. As the recipient's native heart is usually healthy, it can be transplanted into someone else needing a heart transplant. That term is also used for a special form of liver transplant in which the recipient suffers from familial amyloidotic polyneuropathy, a disease where the liver slowly produces a protein that damages other organs. This patient's liver can be transplanted into an older patient who is likely to die from other causes before a problem arises.

WHAT IS CLONING?
Cloning is the creation of an organism that is an exact

genetic copy of another. This means that every single bit of DNA is the same between the two!

How is cloning done?

You may have first heard of cloning when Dolly the

Sheep showed up on the scene in 1997. Cloning technologies have been around for much longer than Dolly, though.

1. Artificial Embryo Twinning

Artificial embryo twinning is the relatively low-tech

version of cloning. As the name suggests, this technology mimics the natural process of creating identical twins.

2. Somatic Cell Nuclear Transfer

Somatic cell nuclear transfer, (SCNT) uses a different

approach than artificial embryo twinning, but it produces the same result: an exact clone, or genetic copy, of an individual. This was the method used to create Dolly the Sheep.