Bioethical Principles

BIOETHICS: ITS ESSENCEBIOETHICS: ITS ESSENCE

The The human beinghuman being, whether normal, , whether normal, physically or mentally incapacitated physically or mentally incapacitated and who is the subject of and who is the subject of HEALTHCAREHEALTHCARE, , RESEARCHRESEARCH, and , and CONTINUING MEDICALCONTINUING MEDICAL EDUCATIONEDUCATION, is a person with , is a person with INHERENT DIGNITYINHERENT DIGNITY..

QUESTIONS RAISED IN QUESTIONS RAISED IN BIOETHICSBIOETHICS

Who is to be born?Who is to be born? What should be done to aid or What should be done to aid or

prevent reproduction?prevent reproduction? What should be done to prevent What should be done to prevent

congenital defects or to improve congenital defects or to improve physical and mental characteristics?physical and mental characteristics?

When and how should life be When and how should life be prolonged?prolonged?

When should one be allowed to die?When should one be allowed to die? Is the medical doctor (or any member Is the medical doctor (or any member

of the medical team) obliged to tell of the medical team) obliged to tell his/her patient that he/she is about to his/her patient that he/she is about to die?die?

Is it morally right for medical Is it morally right for medical professionals to:professionals to:

* clone human beings;* clone human beings;

* experiment on human beings;* experiment on human beings;

* submit persons to technology-assisted * submit persons to technology-assisted fertilization (e.g. artificial fertilization (e.g. artificial

insemination, insemination, in vitro fertilization);in vitro fertilization);

* practice reconstructive and cosmetic * practice reconstructive and cosmetic surgery;surgery;

* transplant organs;* transplant organs;* manipulate genes, etc.?* manipulate genes, etc.?

BIOETHICS VIS-À-VIS THE BIOETHICS VIS-À-VIS THE HEALTH CARE PROFESSIONHEALTH CARE PROFESSION

Health care professionals are Health care professionals are oftentimes members of medical teams.oftentimes members of medical teams.

Hence, they are inevitably exposed to Hence, they are inevitably exposed to and confronted with bioethical and confronted with bioethical problems, issues, and dilemmas.problems, issues, and dilemmas.

And, they must not be And, they must not be morally/ethically indifferent or amoral.morally/ethically indifferent or amoral.

They must make a clear and specific They must make a clear and specific moral/ethical stand. moral/ethical stand.

CHRISTIAN PRINCIPLES OF CHRISTIAN PRINCIPLES OF BIOETHICSBIOETHICS

Inviolability of lifeInviolability of life

- all human life from the moment of - all human life from the moment of conception and through all conception and through all subsequent stages, is sacred.subsequent stages, is sacred.

- life is a gift of God and the fruit of - life is a gift of God and the fruit of love.love.

- all have the duty to affirm, respect, - all have the duty to affirm, respect, love, and defend it.love, and defend it.

Principle of StewardshipPrinciple of Stewardship

- - man has dominion over God’s man has dominion over God’s creations:creations:

* himself/herself (life and health)* himself/herself (life and health)

* other creatures* other creatures

* environment* environment

- this dominion is not absolute but - this dominion is not absolute but relative, shared with the true owner who relative, shared with the true owner who is God.is God.

- Hence, all human beings must take - Hence, all human beings must take care and cultivate (improve) care and cultivate (improve) creatures within the creatures’ creatures within the creatures’ innate nature and teleology, and innate nature and teleology, and within their (human beings) within their (human beings) knowledge and understanding.knowledge and understanding.

- There is an intrinsic value in human - There is an intrinsic value in human life. It is a gift from God. life. It is a gift from God.

PRINCIPLE OF STEWARDSHIPPRINCIPLE OF STEWARDSHIP**states that “our bodies, our life, our states that “our bodies, our life, our human nature and everything in this human nature and everything in this earth are gifts we have dominion earth are gifts we have dominion over”. This means that we are over”. This means that we are responsible for them. Ergo, we responsible for them. Ergo, we should not, as faithful stewards, should not, as faithful stewards, harm but rather improve and care for harm but rather improve and care for them. We have to treat them with them. We have to treat them with utmost respect…utmost respect…

33. PRINCIPLE OF TOTALITY. PRINCIPLE OF TOTALITY

- - This states that “totality refers to the This states that “totality refers to the whole. Every person must develop, whole. Every person must develop, use, care for and preserve all his parts use, care for and preserve all his parts and functions for themselves as well and functions for themselves as well as for the good of the whole. If a part as for the good of the whole. If a part or lower function harms the whole, or lower function harms the whole, this part or lower functions may be this part or lower functions may be sacrificed for the good or better of sacrificed for the good or better of function of the whole”. function of the whole”.

4. PRINCIPLE OF DOUBLE EFFECT4. PRINCIPLE OF DOUBLE EFFECT

* This states that a human act * This states that a human act produces two effects: one good and produces two effects: one good and one evil. To justify the use of this one evil. To justify the use of this principle, the following essential principle, the following essential requisites must be strictly complied requisites must be strictly complied with.with.

Principle of Double Effect: Principle of Double Effect: RequisitesRequisitesA – A – act must be good in itself.act must be good in itself.G –G – good effect must precede the evil good effect must precede the evil

effect, or they must occur effect, or they must occur simultaneously. simultaneously.

E –E – evil effect must not be intended in evil effect must not be intended in itself, or there must be an honest itself, or there must be an honest

intention for doing the act.intention for doing the act.P -P - proportionate reason for doing the proportionate reason for doing the

act.act.

55. PRINCIPLE OF LEGITIMATE . PRINCIPLE OF LEGITIMATE

COOPERATIONCOOPERATION

* * This refers to formal cooperation, This refers to formal cooperation, i.e. when we identify ourselves i.e. when we identify ourselves formally with an immoral act.formally with an immoral act.

* To achieve a well-formed * To achieve a well-formed conscience, one should always judge conscience, one should always judge it unethical to cooperate formally it unethical to cooperate formally with an immoral act (i.e. directly to with an immoral act (i.e. directly to intend the evil act per se.)intend the evil act per se.)

““cooperation is the participation of cooperation is the participation of one agent to produce a particular one agent to produce a particular effect or joint effect. Cooperation effect or joint effect. Cooperation becomes a problem when the action becomes a problem when the action of the primary agent is morally of the primary agent is morally wrong.”wrong.”

6. PRINCIPLE OF PROFESSIONAL 6. PRINCIPLE OF PROFESSIONAL

COMMUNICATIONCOMMUNICATION

* * This refers to privileged This refers to privileged communication that exists between communication that exists between the doctor/care giver and the patient. the doctor/care giver and the patient. To fulfill this obligation to the To fulfill this obligation to the patients, medical/allied health patients, medical/allied health professionals have the responsibility professionals have the responsibility to do the following:to do the following:

a.a. To strive to establish and preserve trust at To strive to establish and preserve trust at both the emotional and rational levels.both the emotional and rational levels.

b.b. To share such information which is To share such information which is legitimately needed, to others, in order for legitimately needed, to others, in order for them to have informed conscience. them to have informed conscience.

c.c. To refrain from lying or giving To refrain from lying or giving misinformation.misinformation.

d. To keep secret information which is not d. To keep secret information which is not legitimately needed by others, for this might legitimately needed by others, for this might harm the patient or others or destroy trust.harm the patient or others or destroy trust.

7. PRINCIPLE OF CONFIDENTIALITY7. PRINCIPLE OF CONFIDENTIALITY

- In close connection with the principle - In close connection with the principle of professional communication is the of professional communication is the principle of confidentiality.principle of confidentiality.

- This means that patient/s have the - This means that patient/s have the right to know the truth about their right to know the truth about their health because they have the health because they have the responsibility for their health.responsibility for their health.

- They also have the right to privacy about - They also have the right to privacy about those aspects of life that do not directly those aspects of life that do not directly affect others. affect others.

- Human community is based on free - Human community is based on free communication, which is impossible if communication, which is impossible if confidence cannot be shared. Hence, confidence cannot be shared. Hence, health care professionals have a serious health care professionals have a serious obligation to maintain such confidence obligation to maintain such confidence that protect the patient’s right to that protect the patient’s right to confidentiality. confidentiality.

8. PRINCIPLE OF AUTONOMY8. PRINCIPLE OF AUTONOMY- This essentially refers to the personal - This essentially refers to the personal choice/determination of the health care choice/determination of the health care users with regard to management or users with regard to management or treatment of their illness / disability.treatment of their illness / disability.- An essential component of autonomy is - An essential component of autonomy is knowledge. Failure to obtain informed knowledge. Failure to obtain informed consent from patients or their guardians consent from patients or their guardians (when patients are incapable to choose) is (when patients are incapable to choose) is to undermine the patient’s autonomy.to undermine the patient’s autonomy.

9. PRINCIPLE OF SOLIDARITY9. PRINCIPLE OF SOLIDARITY

- Solidarity means to be one with - Solidarity means to be one with others. In the provision of health others. In the provision of health care, it is most important for the care, it is most important for the provider to be in solidarity with the provider to be in solidarity with the patient when seeking, always, the patient when seeking, always, the latter best interest. latter best interest.

10. PRINCIPLE OF SUBSIDIARITY10. PRINCIPLE OF SUBSIDIARITY

- Every creature should be entrusted - Every creature should be entrusted with the functions he is capable of with the functions he is capable of performing. It relates to human performing. It relates to human dignity and recognizes persons as dignity and recognizes persons as free and responsible agents able to free and responsible agents able to care and make decisions for them.care and make decisions for them.

- Healthcare should not be transferred - Healthcare should not be transferred to a higher body unless and until the to a higher body unless and until the person is unable to provide for person is unable to provide for himself. Even then, care should be himself. Even then, care should be cooperative and supportive and aim cooperative and supportive and aim towards patient’s self-confidence, towards patient’s self-confidence, independence, and self-reliance. independence, and self-reliance. There should always be free and There should always be free and informed consent. informed consent.

11. PRINCIPLE OF UTILITY11. PRINCIPLE OF UTILITY

- - This states that moral This states that moral rightness of an action is determined rightness of an action is determined by its utility, defined as its by its utility, defined as its contribution to the greatest good of contribution to the greatest good of the greatest number. the greatest number.

12. PRINCIPLE OF PERSONALIZED 12. PRINCIPLE OF PERSONALIZED SEXUALITYSEXUALITY

- Sexuality must be used in keeping - Sexuality must be used in keeping with its human teleology. The conjugal with its human teleology. The conjugal act has inseparable and integrated act has inseparable and integrated UNITIVE UNITIVE (signifies, expresses, and (signifies, expresses, and incarnates the mutual love between incarnates the mutual love between husband and wife) and husband and wife) and PROCREATIVEPROCREATIVE (inherent orientation (inherent orientation to the transmission of life) dimensions. to the transmission of life) dimensions.

MAJOR BIOETHICAL MAJOR BIOETHICAL PRINCIPLESPRINCIPLES

1.1. RESPECT FOR PERSONRESPECT FOR PERSON* Is the recognition of the equality * Is the recognition of the equality possessed by all human beings as possessed by all human beings as unique, worthy, rational, self-determining unique, worthy, rational, self-determining creatures, having the capacity and right creatures, having the capacity and right to decide what is best for them.to decide what is best for them.* Is the responsibility of all to treat * Is the responsibility of all to treat persons as an end and never as a means.persons as an end and never as a means.* This is manifested in autonomy or the * This is manifested in autonomy or the right of non-interference.right of non-interference.

* Persons must be allowed to * Persons must be allowed to determine their own destiny, to determine their own destiny, to deliberate about their plans, choose deliberate about their plans, choose according to their own values, and to according to their own values, and to act accordingly.act accordingly.

* They should be allowed to be their * They should be allowed to be their own persons without constraints own persons without constraints from the actions of others or from from the actions of others or from physical or psychological limitations. physical or psychological limitations.

* In health issues, this relates to * In health issues, this relates to reproductive technology, care for the reproductive technology, care for the elderly, organ donation, exploitation of elderly, organ donation, exploitation of patients, students, or research subjects.patients, students, or research subjects.

* The principle of * The principle of free and informedfree and informed consentconsent is an exercise of respect for is an exercise of respect for person. Every patient has a right to and person. Every patient has a right to and every healthcare provider has a duty to every healthcare provider has a duty to obtain free and informed consent obtain free and informed consent before a procedure is performed on a before a procedure is performed on a person. person.

2.2. JUSTICEJUSTICE

* Also termed as fairnes; means to give to * Also termed as fairnes; means to give to each one what he/she deserves or what is each one what he/she deserves or what is his/her due. his/her due.

* Connotes fair play, keeping promises, * Connotes fair play, keeping promises, role commitments, reciprocity.role commitments, reciprocity.

* This is related to truthfulness, autonomy, * This is related to truthfulness, autonomy, stewardship, solidarity and non-stewardship, solidarity and non-maleficence.maleficence.

Kinds of Justice:Kinds of Justice:

1. Commutative1. Commutative

2. Distributive2. Distributive

3. Legal3. Legal

4. Social4. Social

3. PRINCIPLE OF FREE AND INFORMED 3. PRINCIPLE OF FREE AND INFORMED CONSENTCONSENT

* Mere consent – consent is really out of * Mere consent – consent is really out of ignorance.ignorance.

* Informed consent – individual is * Informed consent – individual is informed of the purpose of the study, the informed of the purpose of the study, the procedures to be employed, the risks and procedures to be employed, the risks and benefits of the procedures, and the benefits of the procedures, and the medical / psychological services available medical / psychological services available if any injury occurs during experiment. if any injury occurs during experiment.

* The individual is encouraged to ask * The individual is encouraged to ask questions and to have other people questions and to have other people present to make decisions. If the present to make decisions. If the subject is a child, both the child and subject is a child, both the child and the parent/guardian are fully informed the parent/guardian are fully informed in a language they can understand.in a language they can understand.

* The subject and the guardian (if * The subject and the guardian (if appropriate) then sign a consent form appropriate) then sign a consent form indicating their understanding of the indicating their understanding of the experiment and their willingness to experiment and their willingness to take part. take part.

* * Presumed ConsentPresumed Consent – for a – for a competent person, consent must be competent person, consent must be clear and explicit. It cannot be clear and explicit. It cannot be presumed. For an incompetent presumed. For an incompetent person, in emergency situations and person, in emergency situations and consent for therapeutic interventions, consent for therapeutic interventions, the attending physician is presumed the attending physician is presumed to be working for the best interest of to be working for the best interest of the patient. (Beneficence)the patient. (Beneficence)

• SUBSTITUTE DECISION-MAKERSUBSTITUTE DECISION-MAKER

* * In non-emergency situations, when a In non-emergency situations, when a person is incompetent to make decision person is incompetent to make decision (too immature or too sick), the decision is (too immature or too sick), the decision is made by a substitute decision-maker (as made by a substitute decision-maker (as in proxy consent). The substitute in proxy consent). The substitute (guardian, family member, designated (guardian, family member, designated surrogate) decides primarily according to surrogate) decides primarily according to what the patient would have chosen, what the patient would have chosen, secondarily according to the patient’s best secondarily according to the patient’s best interest. interest.

Educated ConsentEducated Consent* The individual is given all of the * The individual is given all of the information stated in the informed consent information stated in the informed consent definition. In addition, there is a real definition. In addition, there is a real attempt to educate the individual regarding attempt to educate the individual regarding the physiological, psychological, physical or the physiological, psychological, physical or biomedical underpinnings of the study and biomedical underpinnings of the study and the risks and benefits without disclosing so the risks and benefits without disclosing so much of the study that it biases the subject. much of the study that it biases the subject. The individual is then asked to make a The individual is then asked to make a decision from this educated base.decision from this educated base.

4. NONMALEFICENCE4. NONMALEFICENCE

- - This means that one should not do This means that one should not do and not risk harm (physical, mental, and not risk harm (physical, mental, psychological, social, financial, psychological, social, financial, spiritual, symbolic, etc.) on others. spiritual, symbolic, etc.) on others.

- Hippocrates emphasized that the - Hippocrates emphasized that the healthcare giver should do no harm healthcare giver should do no harm (NON NOCERE).(NON NOCERE).

Examples of Examples of NonmaleficenceNonmaleficence

Providing incompetent careProviding incompetent care Disrespecting dignityDisrespecting dignity Breaching privacyBreaching privacy Causing hopelessnessCausing hopelessness Destroying reputationDestroying reputation Misleading a younger colleagueMisleading a younger colleague Stigmatizing a social groupStigmatizing a social group

5. BENEFICENCE5. BENEFICENCE

- This means one should prevent or - This means one should prevent or remove harm or risk of harm, do remove harm or risk of harm, do good, or provide a benefit. good, or provide a benefit.

- In healthcare, this connotes - In healthcare, this connotes BENEVOLENCE, COMPASSION, and BENEVOLENCE, COMPASSION, and CHARITY.CHARITY.

- This is often extraordinary act.- This is often extraordinary act.

Conditions that require one to Conditions that require one to perform a beneficent act are:perform a beneficent act are:

1. the person aided is at significant risk.1. the person aided is at significant risk. 2. the action is needed and likely to 2. the action is needed and likely to succeed.succeed. 3. there is no significant risk for the doer.3. there is no significant risk for the doer. 4. the benefit for the recipient outweighs 4. the benefit for the recipient outweighs the harm to the doer.the harm to the doer.

Beneficent acts are sometimes Beneficent acts are sometimes PATERNALISTICPATERNALISTIC and may conflict with and may conflict with autonomy and other interests.autonomy and other interests.