Bachelor of Science in Nursing 2YA

ETIC111: BSN 2ND YEAR 1ST SEMESTER FINAL 2021

Coverage for Final: - The health care provider can appropriately assess the
• Autonomy and Beneficence accessibility of the language that will understood by patient.
• Non-maleficence and Justice - Patient can finally render an intelligent decision
• Some Ethical Issues Voluntariness
- Care at the Beginning of Life - This element of informed consent is customarily understood as
- Care at the Promotion of Life free and willfully given by the patient. The issue at hand is that
- Care at the End of Life the patient must be given sufficient time and ample space
The Two function of informed consent
AUTONOMY & BENEFICENCE • Projective (to safeguard against the tension of integrity)
Autonomy • Participative (to be involved in the health care decision
- Derived from the Greek words ‘auto’ meaning ‘self’ and making)
‘nomos’ meaning ‘rule’. Thus, autonomy means self-law or Two basics of obtaining consent
law to oneself. The original usage then of autonomy is to mean 1) Written consent (it is often use upon admission of patient into
‘self-rule’ or ‘self-governance’ of independent city-states the hospital, another used it maybe dream necessary for other
- Capacities for Self-Governance: procedure likely surgery)
• To Understand (moral reflection) the issue and what the 2) Verbal consent (it usually comes the comes in the form of an
situation is all about and to reason out and give one’s implied consent like when a patient seeks consultation with is
opinion/ physician)
• To Deliberate (effective deliberation) by weighing the Significance and justification of informed consent
pros and cons of the issue. 1) Patient of an opportunity to be an informed participant in
• To Make an Independent choice (free choice) basic to health decision.
making an independent choice is one’s capacity to make 2) it is also a legal document and as a form of an assurance of
decisions. safety for the and for healthcare professionals (ex: invasive
Practical Implication of respect for Autonomy in medical procedure such as: surgery, anesthesia, and others)
practice 3) A form of protocol of the research process because most
• Right of the patient, that is, right to self-determination which research involve patient’s lives.
is guaranteed by the patient’s bill of rights. 4) It emphasizes honesty trait of the professional to carry in their
• Informed consent very selves an honest character when asking patient to sign
• Actual directive informed or enlightened consent.
• Advance directive/Living will 5) It reduces risks and avoids unfair treatment and exploitation by
• Refusal of treatment the professional and it is also regulatory and institutional
control.
Informed Consent 6) It also protects the autonomous choice, by which the claim of
- Informed consent is also known as enlightened consent, to patient’s right to autonomy was promoted.
mean, any prior substantial or therapeutic and research Barriers to informed consent vis-à-vis nursing intervention
participation, patient must have a full information of what • Language: the nurse can use intermediary such as a translator
procedure is all about, objective, need and advantage. to translate information to language that can be understood by
- It is also a form of invitation to a patient to participate in his the patient.
health care decisions. • Cultural differences: the nurse can use intermediary or let
- Two Settings: patient meet other persons who underwent the same medical
• Therapeutic setting procedure or treatment of the same culture background as the
• Research setting patient.
• Physical impairment/illiteracy: the nurse can show pictures,
Elements of informed consent: Threshold elements videos, literature, and other related teaching aid.
• Disclosure/Information • Incompetence: the nurse help to ensure that decision made by
• Competence/comprehension the person responsible for the patient is for letters benefit and
• Voluntariness wellbeing.
Disclosure/Information • General it is ethical as well as legal responsibility of the nurse
- The extent of information given to the patient by the to overcome these barriers and everything in her capacity to
physician/nurse relating to the medical procedure. ensure that the patient sufficiently gets all the needed
- The expenses to be incurred, likewise is decisive whether information to make an informed decision.
consent is to be given by the patient for medical procedure
Competence/comprehension Actual directive and advance directive
- The right to self-determination originated from the principle of
- The patient’s level of education greatly affects one’s own
autonomy which entails every individual to informed consent
decision and the level of emotion to the extent relevantly
including the right of person of legal age and sound mind to
possible.
voluntarily refuse a diagnosis.

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- Actual directive is an instruction that was given on the very Resuscitation

moment that is being done by any person with a normal - A form of medical intervention done in a series of steps
condition. directed to sustain adequate circulation of oxygenated blood to
- Advance directive, on the other hand, is an issue given in vital organs while an effective heartbeat was restored.
anticipation of what a person might think would happen - Do not Attempt Resuscitate (DNAR) or commonly known as
relative to his/her health condition. Do not Resuscitate (DNR) a request to forego resuscitation
• Biological parents of the patient maneuvers.
• the oldest child of the patient if of legal age
Indications for DNR orders
• legally adapting parents of the patient
- When the patient condition is terminal, and death is immanent
• nearest kin
so that life support only prolongs the dying process.
• municipal health officer of the place where the hospital is - When the patient is irreversibly comatose or in persistent
located/medical director vegetative state and there is no hope of improvement.
Two forms advance directive - When the burden of treatment far outweighs the benefit
1) Living Will (instructional directive) (adapted from the Southeast Asia Center of Bioethics).
- A will by which any competent adult give direction and - The following are reasons for DNR orders, these were taken
instruction for future care in the event that the patient from different sources gathered:
involve can no longer make due to terminal or severe
• No medical benefit
illness or an impending death
• Poor quality of life before CPR
2) Medical Power of Attorney (Health care proxy)
- A probable patient can name a person trusted so as to act • Poor prognosis
in their behalf as an agent/proxy in making health care • Severe brain damage
decisions in an event of incapacity. • Extreme suffering or disability in a chronically or
terminally ill patient
Practical Implication/issues of limiting Autonomy • Request by a patient or family member
Paternalism (Parentalism) • Enormous cost and personnel commitment as opposed to
- Paternalism (Parentalism) comes from the Latin word ‘pater’ the low probability of patient recovery
to mean father. The conflict between respect for autonomy and • By not administering any cardiopulmonary in the event of
the desire to help the patient (beneficence) brings the problem cardiac arrest
into forefront of paternalism. • We are letting the person go in peace and dignity.
- Paternalism describe as ‘the principle and practice of paternal
administration; government as by a father; the claim or attempt Beneficence
to supply needs or to regulate the life of a nation or - Etymologically, comes from the two Latin words:
community in the same way a father does to the children. • “bonus” where bene was taken to mean “good”
- Two important features of Paternalism: That the father acts • “fic” where fiche was taken to mean “to act or do”.
beneficently, namely, in accordance with the conception of the - It refers to “action done for the good of the others”.
interest of his children and he makes all or at least some of the - In the language of medicine, this principle highlights the duty
decisions relating to his children’s welfare, rather then letting of health provider to do good and take positive steps, such as
them make those decision. prevention and removal of harm to the patient.
- In medicine, Paternalism is applied when health care givers - Beauchamp, Childress & Psyche believed that it could be seen
such as doctor, nurses and the like, assumed the authority to through associated acts of kindness, charity, humanity,
make decision for and in behalf of the patient without their altruism & love.
consent or knowledge. - Beneficence was often thought to broadly include all form of
Placebo actions. (Benevolence & Provenance, intended to benefit other
- (Latin for "I shall please") is a pharmacologically inert persons.
substance (such as saline solution or a starch tablet) that seems - So, beneficence refers to an action done benefit others.
to produce an effect similar to what would be expected of a • Benevolence – refers to the character, trait or virtue of
pharmacologically active substance (such as an antibiotic) being disposes to act for the benefit of others.
The Placebo Effect • Provenance – is the attentiveness dictated by kindness to
- The placebo effect consists of several different effects woven anticipate what one needs since each one of us, has that
together, and the methods of placebo administration may be as inner goodness that pushes us to alleviate the pain and
important as the administration itself discomfort to others.
- a simulated or otherwise medically ineffectual treatment for a - Therefore, Beneficence goes hand in hand with benevolence
disease or other medical condition intended to deceive the and provenance.
recipient. Sometimes patients given a placebo treatment will Obligatory and Ideal Beneficence
have a perceived or actual improvement in a medical condition, - Some ethnical theories like Utilitarianism are based on the
a phenomenon commonly called the placebo effect or placebo principle of beneficence. This means, that goodness and kind-
response. deed form the substratum of the Utilitarian Theory.
- J. Bentham and W.D. Ross differ in the meaning of
beneficence, yet they employed the term beneficence as a
positive obligation, to others, though some critics denied this
kind of beneficence for he holds that the beneficence is a
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virtuous ideal/acts of charity, thus any person therefore is not distinguish the principle of nonmaleficence and beneficence.
morally deficient if he/she failed to act beneficently. But the said authors do not propose a hierarchical order
- Beneficence then is sometimes an admirable ideal of action Instructive Principle Bioethical Principle
that exceeds obligation. One ought not to inflict evil or harm Nonmaleficence
- Nobody denies that the Beneficent acts is morally meritorious One ought to prevent evil or harm Beneficence
and therefore, morally praiseworthy away from a personal One ought to remove evil or harm Beneficence
obligation. One ought to do or promote good Beneficence
- Example: Donating one’s kidney to a stranger. Examples:
- We are not morally required as morality dictates to 1. Do not kill
perform all possible acts of generosity or charity that will 2. Do not cause pain or suffering to others
benefit others. By this, 3. Do not cause offense to others
• Ideal Beneficence means going out of one’s way in order to 4. Do not incapacitate others
do good to others, while Beneficence, is merely goodness to 5. Do not deprive others of the goods of life
others without going out of one’s way. To sum up, Ideal Criteria on Determining Negligence
Beneficence is benevolent act that involves going out of one’s 1. The professional must have the duty to the affected party 2.
way to do good as that of Good Samaritan. The professional must breach that duty
• Obligatory Beneficence is a mandatory act to do good and to 3. The affected party must experience a harm
give aid to those who are in need. 4. The harm must be caused by the breach of duty
Practical Applications of the Principle of Beneficence
- Protect and defend the right of others Principle of Non-Maleficence
- Prevent harm from occurring to others - Affirms the need for medical competence
- Remove conditions that will cause harm to others - A part of Filipino character through avoidance of
- Help persons with disabilities confrontational dialogue that will eventually cause harm to
- Rescue persons in danger others
- The principle of beneficence is already practice by Filipinos
by showing one’s goodness such as, delicate and generous Practical Application/Implication of the Principle of Non-
hospitality and this is shown in different situations like; Maleficence
Sharing of goods & Lending of money, materials, equipment Withholding Treatment and Withdrawing Treatment
and even human resources like bayanihan. - are bioethical issues which can be acted upon or justified
by the following conditions:
NON – MALEFICENCE 1. When the case is irreversible any form of treatment will
- One’s own obligation to do good in the practice of medicine is not benefit the patient
also limited by one’s own obligation to avoid evil/harm. One’s 2. When death is immanent or when patient is already dead
avoidance of harm on others is embedded into what we call, Ordinary and Extra-ordinary Treatments
the principle of nonmaleficence. In medical ethics it has been • Ordinary treatment comprises of the provision of necessities
closely associated with the maxim, primum non nocere, which of life that usually pertain to food, normal respiration and
means, above all (or first) do no harm (Beauchamp and elimination process. Hence like intravenous fluids, nasogastric
Childress, 2001). tube feedings, indwelling catheters, are some among the many
- This maxim expresses an obligation of nonmaleficence in the considered ordinary and necessary measure of treatment and
Hippocratic tradition, ‘I will use treatment to help the sick may be sustained even if the case is irreversible.
according to my ability and judgment, but I will never use it to • Extra ordinary treatment comprises of the use of aggressive
injure or wrong them’. This principle helps in decision-making modalities vis-à-vis the capacities of the family or maybe
about issues that may alter one’s own life, such as on killing some family who can very well afford it, continue to give
and letting go, withholding and withdrawing treatment, use of extra ordinary measure. But this means do not necessarily
extraordinary and ordinary means/procedures and other issues. offer any benefit to the patient.
- Nonmaleficence comes from a Latin word: ‘non’ to mean
‘not’; ‘malos’ from which ‘male’ is taken to mean ‘bad/evil’ Killing and Letting Die
and ‘faceo’ from which ‘fic’ comes which means ‘do/make’. - In ordinary language ‘killing’ is a causal action that
Thus, the term nonmaleficence means not to make or to do bad deliberately brings about another’s death
or to make evil things intentionally. - ‘Letting die’ is ‘prima facie’ acceptable in medicine under two
- In medicine, nonmaleficence means not to inflict harm which conditions:
is not different from ‘not doing evil or bad things. This - A medical technology is useless (medically futile) and patients
principle requires a health care provider to prevent or refrain (or valid surrogate/proxy) have validly refused a medical
from any sort of actions that eventually causes harm to patient technology,
and more importantly when the action is never been justified.
JUSTICE
Distinction Between Non-Maleficence and Beneficence
- Justice comes from the Latin word "jus" means "right".
- Generally, an obligation of nonmaleficence is more stringent
- Justice is a concept of moral rightness based ethics, rationality,
than obligations of beneficence and in some cases,
law, natural law, religion, equity and fairness, as well as the
nonmaleficence perhaps may override beneficence.
administration of the law, taking in to account the inalienable
Beauchamp and Childress suggested the following schema to
and inborn rights of all human beings and citizens, the right of

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all people and individuals to equal protection before the law of defend it. Violation of this principle occurs like in: abortion, in
their civil rights, without discrimination on the basis of race, vitro-fertilization and stem cell research.
gender, sexual orientation, gender identity, national origin, 2) Stewardship. Man msut take care, cultivate, creatures within
color, ethnicity, religion, disability, age, wealth, or other the creature’s innate nature and teleology and within man’s
characteristics, and is further regarded as being inclusive of knowledge and understanding. Violations arises in: surgical
social justice. sterility, substitution of reproduction, use of hormones, intra-
Formal Principle of Justice uterine devices (IUD) donation of sperm or egg genetic
- Aristotle in Nichomachean Ethics manipulation.
• Equals must be treated equally 3) Double Effect. A foreseen evil effect may be allowed if the
• Unequal must be treated unequally foreseen intended good effect is greater than and does not
Material Principle of Justice result from the evil effect. This is applied into maternal-fetal
- Principle that specifies the relevant characteristics for equal conflict, removal of diseased organ like in ectopic pregnancy,
treatment are called "Material" because they identify the anencephalic ifants.
substantive properties of distribution. 4) Nonmaleficence. Do no and risk no harm. This is applied into:
- Engelhadrt, Keusch, Wildesand others have suggested the sterilization, hormones psychological harm psychological and
following material principle of Justice. financial effect of new technologies.
• to each person an equal share 5) Beneficence: do good and provide a benefit. This applies
• to each person according to need when removing diseased organs, facilitating pregnancy,
• to each person according to contribution educating on responsible parenthood.
• to each person according to free-market exchange 6) Respect for Person. 1) Not to be denatured/destroyed. Issues/
- Wildes and others have suggested the following material and violation arises in: artificial methods of reproduction (like:
principle of Justice IVF and AID or AIH), cloning. 2) to be an end and not a
• to each person according to merit means to an end. This happens in contraceptions,
commodifications of sperm/egg, uterus dysfunction, and
• to each person according to effort
embryonic manipulation.
Assisted reproduction
SOME ETHICAL ISSUES
- The right to procreate is limited by man’s nature. Artificial
Care at the Beginning of Life
methods that help the conjugal act and ultimately reproduction
- The way life is brought into existence (reproductive
are praiseworthy.
technology) and the way in which the nature of future human
- Like, the use of folic acid, sex education, fertility awareness
lives are intervened with (like, embryonic stem cell research,
and planning, fertility drugs or hormones, viagra (for sexual
human cell line and commodification) reflect this age of
dysfunction) microsurgery to correct reproductive organ
consumer mentality and market ethics.
defects, delivery with forceps, these assisted reproductions
- Babies have to come at the appropriate time, number and
abide with the bioethical principles.
space. For a service fee, then, sex were selected, genes were
- Artificial insemination by AIH/AID including zygote
improved. Children therefore were made to satisfy the desire
implantation into fallopian tube (ZIFT), intracytoplamic sperm
market (like baby making parent, supplier or baby breaking
injection (ICSI) replace the conjugal act and are illicit.
experimenters). Though this may sound economically good
In-vitro fertilization and embryonic transfer (IVF-ET)
yet its not done for the common good.
- In IVF-ET the gametes are separately harvested, in number of
- Commercialization had led to the continued use and abuse of
eggs are fertilized in ‘Patri Dish’ some zygotes are implanted
human life and human person. Issue at the beginning of life is
into the mother, and unwanted embryo may be removed. This
peculiar because it involves: mother/woman, father/man and
is not in conformity with the following principles:
fetus that cannot give consent, has no wishes and cannot
a) Inviolability of Life (some unwanted zygote are allowed
defend itself. Nurses in this regard must be able to inculcate in
to die)
the minds of those proxies to act in and for the best interest.
b) Stewardship (the procedure is artificial and it substitutes
Natural reproduction the conjugal act)
- The female ovaries expel the mature egg towards the Fallopian c) Nonmaleficence (the baby may develop the ‘genealogical
tubes every 28 days. bewilderment syndrome’, also, if sperm is from a donor,
- The male’s testes produce the sperms which are expelled at the unknown biological lineage may lead to incest or
ejaculation. inherited diseases. Mothers are psychologically harm by
- With the conjugal act the perms are deposited in the vaginal series of unsuccessful attempt)
canal. The sperm travel up the uterus into the uterus into the d) Justice (if private funds are used the prohibitive cost
Fallopian tubes and there fertilize the egg. limits availability to the rich. If public funds are used,
- The fertilize egg (mean the embryo) travels down to the uterus more essential needs are abandoned)
where it is implanted, develops, grow (embryo, fetus) after 9 e) Respect for Person (the human body, the uterus, sperm
months the baby is born. egg becomes commodities trafficked, transferred or sold;
the baby is not a gift but a product of other’s will to be
Principles
disposed of as desired (the unused embryo; ‘take home’
1) Inviolability of Life. All human from the moment of
baby in term of wasted babies are often not shared with
conception (fertilization) and through all subsequent stages is
parents)
sacred. Thus, all have the duty to affirm, respect, love and

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Cloning healthy function. IUD promotes infection as well.

- the reproduction of a genetic copy of another human being Contraception as well promotes a premarital sex,
either through ‘splitting’ of the embryo’s cell or through extramarital sex, or homosexuality.
somatic cell nuclear transfer. The latter, involved the removal d) Respect for person. (to have one spouse use the other
of the nucleus from the unfertilized female egg and its spouse as a means for one’s satisfaction or pleasure is a
replacement by the nucleus of a cell taken from donor. sign of disrespect)
- Embryos are cloned either to provide human embryonic stem Abortion
cells (ES cells) as precursors for differentiated cells to treat - the process of deliberately terminating pregnancy with the
diseased (mean therapeutic cloning) or to produce a new resulting death of an entity or it is a process of deliberately
individual by implanting it in a woman’s uterus (mean terminating pregnancy at any stage of its development. Types
reproductive cloning). Now, harvesting of human ES cells of abortion:
requires destruction of the embryo. Cloning violates: • Direct abortion or induced: it a kind of abortion with the
f) Inviolability of Life (embryo are destroyed in the intentional of immediate purpose of ending or destroying
therapeutic cloning) the fetus at any stage of after its conception.
g) Stewardship (the process is artificial) • Indirect abortion is a process of terminating pregnancy
h) Nonmaleficence (the psychological and physical risks to directly in which the moral object of the action is the
mother and child. In accdition the concept of the ‘family’ therapy of the mother and the death of the fetus is a side
is perhaps destroyed) effect that is inevitably unavoidable effect. Ex., removal
i) Respect for Person (denatured and destroyed by of pathological tube containing a fertilized ovum in an
stockbreeding with no uniqueness ans individuality; ectopic pregnancy, removal of the cancerus gravid uterus.
parents were reduced to a mere provider of human This act is justified by the principle of double effect.
‘materials’, like, sperm, egg and uterus) Obviously direct abortion violates the principles of natural
Human Embryonic stem cells (Human ES cells) reproduction.
- the production of human embryos/the use of surplus embryos - Abortion is done through:
from IVF or aborted embryos or frozen embryos. a) Injection with concentration saline (salt) (it is an
- The isolation of the inner cell mass (ICM) which is cultured injection of a concentrated saline solution into the their
and subcultured to form colonies then cell lines must be done mothers womb. It burns their skin off them while were
early in the embryonic life and destroyed the embryo still alive the babies breathe it in and swallow it, frying
(nonmaleficence). their insides. Some of babies were born alive despite this
- This intentional killing is morally illicit. Thought the end may torture and are then ‘disposed of’)
be praiseworthy as in a regenerative medicine, it cannot justify b) Dilation and evacuation dilation (this is characterized
the means (double effect). To use commercially available or by using a suction tube to remove the fetus and placenta)
supplied ES cells obtained from them is proximate material c) Hysterotomy (abortion by caesarian surgery)
cooperation with scandal in the act of embryo destruction d) Vacuum aspiration (is a method by suctioning of the
(respect for person and nonmaleficence). lining of the uterus through the use of a thin and flexible
tube inserted through the opening of the cervix)
Prevention of reproduction
- There are two ways by which reproduction may be prevented Care at the Promotion of Life: Organ Transplantation and
it is through contraceptive and abortive. There are some Donor
obvious reasons why other people choose this methods, one is - Advance in surgery and introduction of new drugs have led to
space pregnancy, health, economics, unreadiness, no desire to the steady growth of organ transplantation and donation. The
be obligated to try to have children and others. removal of the organ from one being and its implantation into
Contraception another has saved lives or made lives better. Unfortunately,
- any action which in anticipation of the conjugal act (castration, organs are scarce resource.
tube ligation, vasectomy, oral or parental hormones to prevent - Thus, many who need new organs die while on the waiting
ovulation) or in its accomplishment (like, spermatocides in lists. This lack of organs has led to abuses such as robbing,
creams, jellies, foams or suppositories, coitus interuptus, maiming, or even killing of donors, commercialization of
condoms, diaphragm, hormones which thicken cervical organs by health care givers, middlemen or institutions and
muscus) or in the development of its natural consequences coercion exploitation of disadvantaged donors or needy
(like IUD, abortion, fetal reduction) whether as an end or recipients. It is in the abuse that violation occurs.
means, prevents the creation of new life (anti-life).
- Contraceptives treat fertility as a negative value that should be Terms to consider
suppressed. It vilates or it is nonconformity to: • Organ donation means the giving of tissue/organ/body by a
a) Inviolability of life (drugs and devices that inhibit person to another person or to an institution
fertilized ovum transport to and implantation in the uterus • Donor the given who may be a cadaver (with an assumptive
or its development are abortificient. They kill the fetus. document by the donor when still alive or by proxy) or a living
b) Stewardship (it promotes hedonistic mentality with person (either by relatives, non-relative)
refusal to accept the reproductive responsibility of sexual • Vendor is a person who exchange their organ for money
or to recognize a new human being. (perhaps as god is the • Recipient the receiver of the organ given by the donor or
final Creator) institution; a recipient who pay the organ is a buyer
c) Nonmaleficence (castration removes a healthy organ, • Organ transplantation means the transfer or the planting
tubal occlusion or ligation and vasectomy prevents a across of organ from donor/vendor to recipient/buyer
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• Xenotransplantation is the planting of an organ from animal - A new organ may preserve life of the person. To the extent
organ to human beings. that if it is available one has a right to and obligation to get it.
• Allotransplantation it is the transplantation of the organ from Some bioethical consideration are required for it to be morally
one body to another body of the same species. and bioethally accepted:
1) respect for autonomy must be allow the recipient to
Organ donor choose how to get an organ. It requires: to give free and
- Our main concern is to care life that is the life of the donor. informed consent
- The principle stewardship and nonmaleficence state that man 2) there must be justice in allocation. Justice as equal
must take care of his body and do no harm to it. If the donor is benefits for everyone in need would dictate giving nothing
the cadaver, harvesting an organ will do no harm. If the donor to anyone and letting everyone die. It is pointless and
is living, taking away a healthy organ is not taking care one’s harms all.. the following must be consider:
body: no life is saved, no health is restored. a) The criterion for judging equality is based on the
- Removal of organ may even be mutilation. However, a very chance of success
proportionate reason and a meritorious act my override the b) The ability to pay the costs of the transplant and the
rule of stewardship and nonmaleficence. expensive anti-rejection medication determines
- The rule of unselfish love, solidarity love of neighbor, success and access
beneficence, and charity these may supercede the rules of c) Given the case that both are capable to spend has
stewardship and nonmaleficence. success and access, the first come first serve must be
- In such a case it is praiseworthy, for it takes what it means to serve.
belong to a human society that we are fulfilling our duty to - What the nurse can do, they must contribute on the communal
one another (deontological duty) and to contribute to the goal dialogue and public education must be given, so that the main
of medicine (healing). By this it makes the giver a better goal of organ transplantation shift back to its true nature of:
person. Still in spite of its meritorious promise there are some a. commodities to self love
requirement before an organ may be considered a) Commercialization to charity
moral/bioethically acceptable: b) Potential donors must be protected against harm, thus
1) The harm and risk must be minimal and proportionate to become an advocate of the donors
the benefits to be derived. Things need to be considered: c) Educating donors that selling organ is not encourage
a) Accurate definition of death must be followed and d) Nurse should address the underlying poverty, ignorance
observed and vulnerability of people that sells their organs; organs
b) The dying cannot be killed ‘should not be for sale’
c) The organ to be removed must not be a necessary
condition for life or for personal procreation, like, brain Care at the End of Life: Euthanasia and Physician Assisted
and gonads Suicide
d) An part of the body that can easily be regenerated can be - One’s values regarding life and death are reflected in how one
given such as blood, hair, bone marrow dealt with the dying. If one cannot bear to see suffering, then
e) A second kidney or a portion of the liver these are nor one resorts to an “advance” death, such in euthanasia, suicide,
necessary for the personal or procreational identity or physician assisted suicide.
2) The donor must be care for before, during and after the - If one sees life as the highest value with death as a form of
donation. This includes the following consideration: human defeat, or if one is overly influenced by available new
a) Proper screening technology and biological idolatry then one does everything to
b) Standard of health care prolong life beyond one’s one time and this is known as
c) Reimbursement of medical expenses dysthanasia.
d) Disability and livelihood lost (burial expenses of the - On the other hand, if one sees death as the culmination of a
cadaver) good life, to be valued only until its natural end, one looks for
e) Prevention of discrimination in job a good death this is orthothanasia.
f) Prevention in community acceptance - Before proceeding to the types of death, it is important to
3) The intrinsic worth and dignity of the donor must be determine first signs of the moment of death, signs of death
respected. The following must observe: and when to pronounce that a person is dead.
a) Free and informed consent must be given
Moment of death
b) Information given should include process of matching, the
1) Inevitable and critical moment when organism ceases to
chance of success of the transplant and permission to
function as specified, unified, homeostatic system and
refuse
becomes disorganized into a mere collection of heterogeneous
c) Financial need and ignorance make te marginalized
chemical substance. To know that body is disorganized we
vulnerable to exploitation
must at least become sure of three things:
4) In case of cadaver, consideration must be observed:
a) That the body does not now exhibit specific human
a) consent for the donation must be given or obtained
behavior
specially person that met an accident
b) The body does not function humanly in the future
Organ Recipient c) The body has no more radical capacity for human
- Stewardship dictates that in case of serious illness man has the functions due to its lost of basic structure required for
right and the obligation to take necessary measures to promote human unity
life and health.
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 ETHICS – BSN 2ND YEAR 1ST SEMESTER FINAL 2021

- The third reason is necessary since medical experience replaced by an angiogram it is an apparatus to test the blood
had shown that persons who are in coma nevertheless flow in the cerebellum of the patient)
have sometimes recovered full human consciousness. Types of Death
Such resuscitation is possible, however, after true human Euthanasia
death some cells or even organs of the human body for a - An action/omission which of itself or by intention causes
time by artificial respirator, continue to exhibit some life death, in order that suffering may be eliminated. It
functions but these functions are not those of human procures/imposes death before one’s time.
organism but simply a residual life at level of - Euthanasia is popular for a variety of reasons:
organization like a plant or animal. Thus, the essential a) Utility: the economic constraints from the escalating
point of determining human death is not to decide health costs for the growing elderly population especially
whether any life is present, but whether human life in the chronically ill, disabled.
most radical sense of a unified human person is still b) Hedonism: when quality of life is poor or life is a
present. burdensome and useless then the person can be killed.
2) Life force of cell is no longer united to the matter with which Since patient who see themselves as a burden to others are
it was at any times united. guilty to be alive.
3) Religious orientation, the separation of the body and the soul c) Autonomy: a request for an early death may be an attempt
(medically, it is understood as, body’s lack of sensation and of the patient to regain control: even if it be only in
self-movement. deciding when to die, it is practicing the “right to die”
4) The lose of touch irrevocably with a person who previously - Types of Euthanasia:
was able to communicate and to share our human community a) Voluntary and involuntary (patient’s initiative)
of thought, of love, of freedom and or creativity. b) Active and passive (healthcare provider’s initiative)
Signs of death - Human life must be promoted because we are as stewards of it.
1) Human organism is irreversibly dysfunctional and dead Filipinos have seen that disabled newborn as “good luck” and
2) Less conclusive, absence of breathing and heartbeat caring a sick person is a privilege. In solidarity, one can’t
abandoned, replaced, worst of all, kill another person. May it
- Now, the signs are not a guaranteed bases and signs of death be in the name of economy, practicality, compassion or
due to some technological advancement that is perfected to aid autonomy. procuring death is a perversion of a diseased
the lungs and heart to functions artificially as in resuscitation. society made worse if done by a family or healthcare provider.
Such mechanism of resuscitation restored back and sends It is then a betrayal of the trust and respect that health care
blood through the body, even if after the unity of the body providers are known as healers. It harms the victim and at the
cease to exist. Be that as it may, it does not lead to a same the survivors in the spirit of oneness to the one that
conclusion that an individual organ simulates unity, unity or passway.
organism is no longer present because the organs would cease Dysthanasia
to exist right away if the mechanism is removed. Thus, an - the delaying or postponing death beyond its natural time by all
artificial sustained heart and lung activity is not a proof that means available.
human life still remains. That is why as long as this heart and - Dysthanasia is popular for the following reasons:
lung is sustained by mechanical device that runs it artificially a) Doctor’s training (reasons: treating is more comfortable
the traditional bases of death is impossible to verify. Thus, we than not treating, doctor’s felt guilty to abstain, death of
ask the question? What then is the basis or are there other patient is seen as a failure of management)
clinical signs that can be used not to constitute a new b) Technologic imperative (reasons: advances and success
definition of death rather as an alternative, complementary pushes the doctor to use everything, that is, malignant
ways the same essential fact, namely, the irreversible cessation over-diagnosis and over-treatment. It is also biology
of spontaneous heart and lung functions. rather then personhood is the object of medical attention)
- Aside from the new technology used, another reason is the c) Ignorance (reasons: proxy’s are unaware of the distinction
possible organ transplant of heart and kidney. It is said to be between killing and letting die; lack of information with
that the success of transplanting of heart will likely to be very regard on prognosis pain high quality of end of life care,
successful if the organs to harvested from a body through the best place to die)
which blood is circulating. Hence, surgeons, kept the body d) Hospital culture (reasons: rights of patients are considered
alive in the respirator. So then, how is it possible to be sure as preference rather than directives)
that the donor is in fact dead? e) Fear (reasons: doctor’s worry about on the accusation of
Signs of a dead person legal liability and malpractice if everything were not
1) Cardiovascular clinical signs (this is used when the person is done)
not attach to respirator. Thus, reliance on technology must be f) Philippine culture (to add in the filipino hospital context)
moderated rather than encourage) (reasons: the filipino non-confrontational attitude makes
2) The new clinical sign must be ascertained by the well-trained all concern hesitate to hear ‘badnews’, instead the ‘status
professionals (basis must be properly observed. That is for no quo’ is the main focus)
less than 24 hours when it uses the eeg or - Living should not be a penalty to be prolonged at all cost. To
electroencephalogram as it is done in the usa: harvard criteria cause suffering unnecessarily in unworthy of trust and respect
for brain death of 1968, this is used to person who is under a the healthcare provider has. Priority of using the last moment
hypothermia and drug-induced coma. But today, short of life must be given to finish one’s own responsibilities to
intervals is now allowed within 6 hours, and the eeg is being others.

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