NCM 108

BSN2 1st SEM MIDTERM 2020

INSTRUCTOR:

HUMAN SEXUALITY & REPRODUCTION

Human Sexuality – the way we experience & express selves as sexual beings.
-whether you are a male or female, this has a major influence on the development of your sexuality as
an individual.

Sexuality – is an integral part of one’s personality.

-covers a broad spectrum; it is understanding your sexual feelings, thoughts, attractions & behaviors
towards other people.
-it is diverse & personal yet an important part of who you are.

Other sources of human sexuality say that it is an expression of sexual sensation & intimacy b/n persons.
It is also an expression of identity through sex.

Sex – on medical POV, generally it refers to biological differences between male or female such as the
genitalia & genetic differences.
-different things w/ different people.
-intercourse or love-making.
-sex is considered a taboo.
-unmentionable;
-not to be discussed in public.
-seldom a topic b/n children & their parents (b/n the young & their elders according to Gorospe) & is
considered as a mortal sin.
-open & sane discussion of sex is “verboten” (bawal).

According to Timbreza, F., the meaning of sex to the individual is that:

● It is a method of experiencing each other’s worth. (It is realizing that you need that person to
complete you & in return, this person values you as part of his being to complete his life.)
● An appeal for mutual care. (This is possible only when a person loves & trusts another person &
shares oneself, freeing themselves from self-centeredness.)
● Sharing each other’s being. (True love says I am giving myself to you. Sharing in other’s being
means giving the best of oneself to the one you love.)

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 ● Self-discovery as persons. (As persons, we talk(?) about awareness of self through sexual
response. Common statements include “I see myself better in the other'', “I love Retro (?)
because she sees the best in me”.) thus,
● Making each be truly himself/herself

SEXUAL ETHICS – a study of ethics in relation to human sexuality & sexual behavior.
-seeks to understand, evaluate & critique the conduct of interpersonal relationships & sexual
behavior/activities from a social, cultural & philosophical perspective.

Human Reproduction – outcome of any form of sexual reproduction that would result in fertilization &
having an offspring.
-end point of human sexuality & through this, we multiply/reproduce.
-actions that involve sexual actions or love making by a man & woman.
-this act is allowed b/n couples only who are united by love & blessings in ceremony called marriage.

Marriage – state of being united as spouses in a consensual & contractual relationship recognized by
law. Consensual because it needs the consent of couples & contractual because they will be bonded by
the marriage contract.
-refers to a legal contract & civil status, a religious rite, & a social practice, all of w/c vary by legal
jurisdiction, religious doctrine & culture.
-a prominent institution regulating sex, reproduction & family life.

Family Code of the Philippines, (August 3, 1998):

● Marriage is a special contract of permanent union b/n a man & woman entered into in
accordance w/ law for the establishment of conjugal & the family life (Light & Keller, 1985)

● Legal capacity of the contracting parties (18 years or upwards), who must be a male & female;
& consent freely given in the presence of the solemnizing officer. (All marriage will be valid
unless these essential requisites are present)

FORMAL REQUISITES OF MARRIAGE

Article 3 of the Family Code of the Philippines, the formal requisites of marriage are:
● Authority of solemnizing officer; a valid marriage license; and a marriage ceremony which takes
place w/ the appearance of the contracting parties before the solemnizing officer & their
personal declaration that they take each other as husband & wife in the presence of not less
than two witnesses of legal age.

Article 4:
● The absence of any of the essential or formal requisites shall render the marriage “void ab
initio” (void from the beginning) except as stated in Article 35.

ASPECTS OF MARRIAGE:
● First, the legal POV posits that marriage is a contract.
● Second, religious POV posits that marriage is a sacrament.

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 ● “What God has put together let no man put asunder.”

WHAT KIND OF SEXUAL BEHAVIOR IS PERMISSIBLE?

General views:
● Only in marriage
● Commitments formed b/n consented adults
● By adults who are bound by love or commitment
Obviously, only inside the 4 walls of a married life when sexual behaviors are allowed & also b/n in the
commitments formed b/n consenting adults. Moreover, sexual behaviors are also allowed by adults who
are bound by love & commitment w/c can be displayed when marriage is binding the 2 individuals.

NATURAL LAW – perceives sex as sacred & God-given.

-It is clearly stated in the scriptures that God created man & woman as sexual partners in order to be
fruitful, multiply & replenish the earth.
-immorality comes in when sex is abused & misused.

THOMAS AQUINAS

⮚ Procreation is natural and other acts considered non-procreation are immoral (conventional view)
⮚ Moral actions follow that natural course of nature.
⮚ On the other side, Aquinas contradicts activities that even committed couples might practice such
as oral sex, masturbation, sex with contraception use, sex when couples are infertile and sex after
menopause are not allowed.
⮚ It emphasized that sex is only intended for procreation.
⮚ Any sexual act done apart from this reason is wrong or immoral.
⮚ He also condemns sexual acts like masturbation, homosexuality and unnatural style of sexual
intercourse

OTHER POSTULATES:
⮚ Other postulates say that the basis of high general conception of morality is that actions are wrong
when we treat people disrespectfully as mere things. (RESPECT for HUMANITY)
⮚ “When I steal from you, I treat you as a thing”, with complete disregard for your value as a human.
⮚ Sex is permissible between legally married man and woman (Moral Norms).
⮚ Sex is only permissible under basic standards that are moral (no one is cheated or harmed).

The moral issues here are identified as whether permissible or not with which Aquinas posits that these
are impermissible.

Acts that are impermissible:

✔ Adultery
✔ Pre-marital and Extramarital sex Fornication
✔ Contraceptives
✔ Homosexuality
✔ Non-procreation acts
✔ Oral sex

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✔ Masturbation
✔ Anal sex

ISSUES ON SEX OUTSIDE MARRIAGE

1. FORNICATION
⮚ Sexual intercourse between people not married to each other.
⮚ It is a sexual act taking place outside of marriage.
⮚ In some religions, fornication is considered as sin.
⮚ In the original sense, fornication is a synonym for adultery.
⮚ But people also numerously use fornication to mean many kinds of just sex at all.

2. ADULTERY (woman)
(Philippine Law)
⮚ Is committed by any married woman who shall have sexual intercourse with a man not her husband
and by a man who has carnal knowledge of her knowing her to be married. (Even if the marriage be
subsequently declared void)
⮚ A single act of sexual intercourse constitutes adultery, and a more long-term sexual relationship is
sometimes referred to as an AFFAIR.
⮚ Although the sexual activity that constitute adultery vary as well as social religious and illegal
consequences the concept exists in many cultures and in similar in Christianity, Islam and Judaism.

3. CONCUBINAGE (Man)
⮚ Any husband who shall keep a mistress in the conjugal dwelling.
⮚ Or shall have sexual intercourse under scandalous circumstances lead the woman who is not his
wife or shall cohabit with her in any place.
⮚ This adultery is committed by a wife and should be charged together with the man/other man.
⮚ While concubinage is committed by a husband and should be charged together with the other
woman or concubine.

HOMOSEXUALITY
⮚ It is a type of sexual deviation w/c is also known as HOMOEROTISM.
⮚ This refers to sexual relations to the same sex.
⮚ Among men homosexuality is often called PEDERASTY which denotes homosexual’s anal
intercourse.
⮚ Among women it is called LESBIANISM - this comes from the word LESBOS where there is an island
in Greece whose inhabitants are alleged to be mostly homosexuals.

ETHICAL PRINCIPLES APPLIED

On the many issues of sex outside marriage and sexual deviations 4 ethical principles address them. May
these help us understand the rightness and wrongness of behaviors and actions around us.

❖ NATURAL LAW
⮚ Under the natural law, issues on sexuality are dealt with identifying if the sexual deviations come
from natural or congenital aberrations(?)

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⮚ These sexual abnormalities may be considered as INVOLUNTARY or non-imputable.
⮚ Therefore, such actions may have no moral significance in as much that they are organic, aversions
or even a form of neurosis(?)
⮚ On the other hand, once the person is aware of the rightness and wrongness of such actions and
behaviors and still does them it becomes VOLUNTARY or imputable sexual deviation. Therefore, this
is considered as immoral.
⮚ An example of this is a sex surgery

❖ KANT’S PRINCIPLE (Moral Injunction)

⮚ On the moral issue of masturbation, pornography and prostitution.
⮚ Kant’s moral injunction encourages individuals to “treat people either yourself or others, always an
end and never a means.”
⮚ In sex stimulation for example - the use, misuse and abuse of self and others is treating them as a
mean.
⮚ To respect and protect one’s dignity is an end.

❖ RAWL’S ETHICS OF JUSTICE

⮚ Any form of human exploitation therefore which is deliberately intended to benefit one’s person or
group of persons is not morally legitimate
⮚ (Sexploitation or exploitation of sex is not legitimate)
⮚ The role of women in closing a big deal among big time businesses through a common standard
variety procedure is not only a form of sexism but a man’s inhumanity to women.
⮚ Showing justice is to respect others as persons and never to take advantage of them nor use them
for personal gains.

❖ FLETCHER’S SITUATIONISM
⮚ An evil means does not always nullify a good end; it all depends upon a given situation.
⮚ Often times circumstances do alter cases
⮚ A mother for instances who have 5 children left by her husband because of another woman, whom
resulted to prostitution for well-being and for survival of 5 children
⮚ Therefore, an act which is right in some circumstances may be wrong.

HUMAN SEXUALITY
Human sexuality is indeed a difficult topic to tackle, for their actions and behaviors are not merely
reflections of their desire to be a deviation of what is normal. Yet there are deep reasons for the persons
they become now.
For all the experiences which push them to be despite knowing the natural law and still doing it and
keep on doing it, a valid reason behind keeps them from that position.
Our role maybe is to correct these, a natural sexual behavior but the corrections need to start from the
person themselves and their willingness to change.

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ISSUES ON CONTRACEPTION & ARTIFICIAL
REPRODUCTION
(Morality and EthicoMoral Responsibilities)

CONTRACEPTION – some claim that it is synonymous w/ family planning and that of birth
control but family planning is a planned or responsible parenthood. While birth control is the
prevention of birth and contraception on the other hand denotes prevention of conception

⮚ Concerned w/ the rightness and the wrongness of the use of various methods by w/c
conception can be prevented in the conjugal union. The instrument used to abstract union
b/n female egg and male sperm cell w/c can either be physical or chemical
⮚ Voluntary prevention of conception by positive use of artificial means w/c hinder the
generative process.
⮚ Its use does not prevent a person from having goitus rather it hinders the meeting of sperm
cell and egg cell

Sterilization
- It is the mutilation of sexual power in a man or woman
- Has many types
- As to decision: voluntary or involuntary
- When the person requests the procedure, it is voluntary, w/ that compulsory or
involuntary it is done by order of public authority
- Purpose: therapeutic, contraceptive, eugenic & social, or punitive

Types of sterilization accdg. to Purpose:

● THERAPEUTIC STERILIZATION is done to save one’s life

- Governed by the principle of totality
- An individual has the right to destroy their organs for the general well-being of the whole
body
● CONTRACEPTIVE STERILIZATION is intentional and is justifiable for the following reasons:
1. Serious illness of either husband or wife. This is done to prevent having an offspring w/
the same disease

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 2. Genetic abnormality. To avoid birth of malformed or abnormal babies coming from
parents who are carrier of defective genes
3. Financial burden. A couple for example may not be financially capable of supporting
another child so Contraceptive Sterilization can be done
4. Childbearing puts one’s health in danger
● EUGENIC AND SOCIAL STERILIZATION are performed to prevent conception of undesirable
and physically or mentally unfit offspring
● PUNITIVE STERILIZATION is done as punishments for crime.
- Example: rape and other sexual related offenses

JUSTIFICATION OF CONTRACEPTION

⮚ Parenthood and childbirth are matters of moral RESPONSIBILITY and INTELLIGENT

CHOICE. The use of contraception seeks to promote maximum enjoyment of a happy life.
Anchored on the right of an individual to grow the soul, mind and body. The growth of a
child may not core by chance or accident but by design and choice
⮚ An individual should be the one to DETERMINE HIS/HER FERTILITY and should be the one
to control his/her fecundity. One’s procreativity should not be left to faith(?) or blind forces
of nature
⮚ One should be able to decide how many children one is able to bear and support. The
sexual union must consider the future child inherent right to a dignified existence.
Unrestricted procreation is detrimental to the health of the mother
⮚ Contraceptive technology makes men and women persons of will and decision, and not
merely inert and powerless. Subject to church prescription or the divine will. A couple
would bear the consequences of their moral decision and nobody else
⮚ Contraception checks the transmission of recessive disorders or genetically-linked
diseases.

APPLICATION OF ETHICAL THEORIES

NATURAL LAW
- divided views
- any interference of procreation is forbidden
- rhythm method is licit since it does not interfere w/ law of man’s nature.

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 - However, if the used of contraception is for promotion of responsible parenthood it is not
conflict w/ natural law
- Catholic church sees voluntary sterilization as intrinsically wrong because it involves
frustration of natural power and functions hence contrary to the natural law

UTILITARIANISM
- Use contraception and sterilization in terms of great happiness and benefits
- PRAGMATISM: practicality, usefulness and beneficially that the practice of contraception
can provide for the couples who want to limit the numbers of children they can support
and educate w/o sacrificing the unitive element of their marriage

SITUATIONISM (Fletcher)
- Contraception and sterilization w/n the context of a given situation
- Everything is either good or bad depending on circumstances
- In his views, making babies is as good as making love, that babies are all to be wanted and
intended, not born by chance or accident. Hence, the best way to make love w/o making
babies is the use of contraception

ADDRESSING INFERTILITY
Use of artificial reproduction

⮚ Other term is Assisted Reproductive Technology (ART)

- a method used to achieve pregnancy through artificial or partially artificial means

Techniques:

1. Artificial insemination
▪ Introduction of sperm into the female’s vaginal vault, uterus or cervix for the purpose
of achieving pregnancy other than sexual intercourse

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 2 processes:

● Homologous or AI from husband (AIH) – the sperm used in artificial insemination comes
from the husband of a woman
● Heterologous or AI from a Donor (AID) – the sperm used is not from the source of the
husband but from a donor

Issues:

❖ Only AIH is acceptable

❖ AID is considered as “permitted” adultery
❖ Health care provider should not support AID

Justification of AIH:

❖ Husband’s impotence
❖ Anatomical defects of urethra
❖ Deficient sperm count (oligospermia)
❖ Some type of spinal injury and other physical problem that hinders normal
intercourse
❖ Vasectomy
❖ Physiological obstruction w/c the sperm cannot reach the ovum

Justification for AID:

❖ Husband is sterile
❖ Husband is carrier of a hereditary disease
❖ Wife’s oocyte is defective
❖ Wife’s fallopian tube is severely damage by gonorrhea

Moral Considerations:

❖ Does the true father have moral obligation to the conceived child?
❖ Does the stepfather offer or give authentic love to the child?
❖ Can the members of the family show acceptance to the child?
⮚ Probably these issues can be resolve only by the couple themselves
⮚ To cut a string of affinity or attachment of the child and that of the donor his identity must
be kept in secret otherwise legal and moral chaos will come along the way

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 Application of Ethical Theories:
Natural law ethics
⮚ Considers AI to be Immoral. Since the child is not the fruit of conjugal act or an expression
of personal love
⮚ Transfer procreation in the laboratory. AI splits the sexual unity of husband & wife in
marriage into laboratory, conjugal love is completely lost
⮚ Contrary to the unity of marriage, to the dignity of a couple, to vocation proper to parents,
and the child’s right to be conceived in this world in marriage and from marriage

Situational ethics
⮚ Endorse AI as right to overcome childlessness.
⮚ Parenthood is not a matter of biological reproduction, rather accepting the responsibility
of caring and rearing a child

Utilitarianism
⮚ AIH and AID promote more good than harm, more happiness than unhappiness, more
pleasure than pain for a childless couple
⮚ Therefore, it is being advocated

Pragmatism ethics
⮚ AI is the most practical, beneficial and useful technique to be undertaken by spouses w/
reproductive problems

Kant’s Ethics

⮚ AI should be agreed upon by both spouses and none of the spouses should be used only as
means to an end

2. In-vitro fertilization
▪ Latin word in vitro w/c means “in glass”
▪ Historically refers to the glass containers like test tubes, beakers, and petri dish used in
the experimentation for the purpose of fertilizing the egg and sperm

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 ▪ An artificial process of fertilizing the egg cells by sperm cells outside the woman’s
reproductive tract
▪ One of the products of genetic engineering and also called procreation w/o sex or
baby-making w/o love-making

Goals of IVF:

❖ To observe and evaluate the process of fertilization in vitro

❖ To test the effectiveness of antifertility agents
❖ Evaluate the fertilization of the ova
❖ Asses the structural and biochemical normality of the conceptus
❖ To better understand the mechanism of genetic studies
❖ To advance understanding of normal and abnormal cell growth and differentiation
❖ Increase knowledge that is useful in contraceptive technology
⮚ Most of the time the In-Vitro fertilization is done to be able to experiment and achieve all
these outcomes using IVF

Application of Ethical Principles:

Natural law
⮚ Against IVF since it is done outside the conjugal act and rather than in laboratory thus
against the law of nature

Utilitarianism
⮚ Claims that it will be a solution for a childlessness

Kantian ethics
⮚ Emphasize that resorting to IVF should bring joy to promote good than harm is acceptable

3. Surrogate motherhood/ Surrogacy

▪ Latin word surrogatus w/c means “in place of another”
▪ Biomedical technique whereby a fertilized ovum is implanted into the uterus of
another woman.

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 ▪ In this, women carry the baby to term either as a favor or for a fee. It is in this
financial arrangement the procedure is often termed as womb-for-hire, rent a
womb or uterus for rent

Indications:

❖ Women w/o uterus, but w/ one or both ovaries functioning

❖ Women w/ congenital absence of uterus and for women who undergoes
rectomy
❖ Women who suffered repeated miscarriage
❖ Severe heart disease, or pregnancy is contra-indicated

Methods of Surrogacy:
● Traditional surrogacy - surrogate mother is impregnated naturally or artificially but the
resulting child is related to the surrogate mother by genes
- Traditional surrogate is the baby’s biological mother since the child was conceived from
the union of her egg and the father’s sperm

● Gestational surrogacy- the pregnancy results from the transfer of an embryo created by the
in-vitro fertilization (IVF) in a manner so a resulting child is genetically unrelated to the
surrogate
- Gestational surrogate mothers are also referred to as gestational carriers

Types of surrogacies:
Commercial surrogacy – it implicates that the surrogate mother is rewarded w/ compensation.
This covers medical and miscellaneous expenses related to pregnancy.

Altruistic surrogacy – conceals that surrogate mother agrees to become pregnant and delivers
baby w/o any financial compensation

Ethical and Moral issues:

⮚ Surrogacy destroys the sanctity of marriage
⮚ Destroys the spiritual connection b/n the parents and child
⮚ Bring the child & mother bearing it to be objects of negotiation and purchase
⮚ Turns women into reproductive machines

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 Application of Ethical Principles:
Kant’s ethics
⮚ Claims that people should not use other people as a means to our ends
⮚ As all people should be treated as ends themselves
⮚ In the light of gestational surrogacy, gestational surrogacy seems fully morally objectionable
⮚ Surrogacy destroys surrogate mothers’ integrity as human beings. In every aspect man
should be treated equally
⮚ He also insisted that everyone has dignity rather than cries. Human being should not be
reduced to things that are used

Utilitarianism
⮚ From a utilitarian POV, international surrogacy is generally MORALLY PERMISSIBLE because
there are many more benefits to all parties involved than it harms either party
⮚ Whatever is beneficial to the greatest number of people, is considered to be good. Reals
whatever is beneficial to the least number of people is considered least good
⮚ From these ethical stands, surrogacy can be perceived as morally right. The intended
parents receive a much-desired child

Legal issues:

❖ The Calvert-Johnson Case (reading assignment)

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MORALITY OF ABORTION AND RAPE AND OTHER

PROBLEMS RELATED TO THE DESTRUCTION OF LIFE

NCM 108 Lesson 5

Abortion

⇨ Termination of pregnancy, spontaneously or by induction.

⇨ The expulsion of a living fetus from the mother’s womb before it is viable.

5 TYPES OF ABORTION

1. NATURAL ABORTION
⇨ Also known as “Spontaneous” or “Accidental”, “Miscarriage”, “Unintentional”
⇨ Expulsion of the fetus through natural or accidental causes.
⇨ It assumes a moral bearing only if it is a voluntary cause.

2. DIRECT OR INTENTIONAL ABORTION

⇨ Deliberately induced expulsion of a living fetus before it has become viable.
⇨ This can be done with jogging, horseback riding and aerobic exercises which causes the
inflammation of uterine wall thereby inducing abortion

3. THERAPEURTIC ABORTION
⇨ Deliberately induced expulsion of the fetus in order to save the mother’s life.
⇨ Perform by the doctor when the life of the mother is in danger of death.

4. EUGENIC ABORTION
⇨ Recommended when there is defect found in developing fetus.
⇨ It’s better for a child not to be born than for it to live miserable life
⇨ It is termed eugenic because it is meant to get rid of the babies and thus preventing them
contaminating the human species.

5. INDIRECT ABORTION
⇨ Removal of a fetus is due to secondary effects of a legitimate or licit action.
⇨ This is an instance of a double effect principle.
⇨ Example: woman who has asymptotic pregnancy

ENSOULMENT PHENOMENON

☞ Occurs from the moment of conception

-To expel or abort is to commit murder
☞ Occurs NOT from the moment of conception
-abortion before implantation is morally licit.

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 a. Immediate Hominization
⮚ Human people exist immediately upon conception.
b. Delayed Animation
⮚ Upholds that ensoulment occurs later but not from the moment of conception.

3 VIEWPOINTS OF ABORTION

1. CONSERVATIVE
-abortion is never permissible
2. LIBERAL
-abortion is always permissible
3. MODERATE OR INTERMEDIATE
-permissible up to a certain age of fetal development.

POSITIONS

Pro-LIFE

-disapproving abortion

Pro-CHOICE

-approving views on abortion

JUSTIFICATION OF ABORTION

❖ Personal Reasons
✔ Freedom of choice
✔ Liberates decision
✔ Safeguards mother
✔ Protects reputation
❖ Social Reasons
✔ Support pro-choice position
✔ Alleviated economic, sociological or demographic problem
❖ Fetal Reasons
✔ Prevents birth or terribly malformed or defective children

APPLICATION OF ETHICAL THEORIES

AUTONOMY

-the mother has the freedom to decide on her own body

BENEFICENCE

-based on the obligation to the pregnant woman to protect her life or her health.

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DOUBLE-EFFECT

-can also applied on this issue.

SEXUAL ASSAULTS

-crime against persons

-difficult and sensitive topic to discuss.

-most of the time young girls are the victims.

Rape

-is forced, unlawful sexual intercourse without the victim’s “Consent”

-it can happen to both men and women of any age.

: Is rape and sexual harassment similar?

No, sexual harrassment means the victims is the physically harm which showcase men dominant while Rape the
victim is rabish like an animal for the fulfillment of desire or lust on another.

TYPES OF RAPE

1. ACQUAINTANCE RAPE/DATE RAPE

-when the victim and the rapist know each other

2. SPOUSAL RAPE
-Date between married couple

3. GANG RAPE
-when the posal is being raped by a group of people.

4. Minor Rape
-occurs when a child is raped by an adult.

5. College Campus Rape

-when the rapist is done inside the college premises or by a college man or woman.

6. Statutory Rape
-when adults engaging in consensual sexual relations with sexual mature minors under the age of consent.

ETHICAL APPLICATION

● KANT’S ETHICS

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 -deemed immoral by Kant’s standards as they dehumanize the victim

● UTILITARIAN APPROACH
-rape is never moral

● CONFIDENTIALITY
-we need to maintain anonymity of the client’s and keep records confidential

HOW TO HANDLE RAPED VICTIMS

✔ Crisis Intervention Counselors

-this is done by helping victims overcome trauma
✔ Victim Advocates
-by speaking for the victim in behalf of the victim
✔ Medical Personnel
-properly assessing the victim and beings sensitive of the victims feeling
✔ Educators
-to both? the significant others and to legal medical mental health personnel with home the victim
may interact.

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DIGNITY IN DEATH AND DYING

NCM 108 Lesson 6 “DIGNITY IN DEATH AND DYING”

PART 1

DIGNITY AND DEATH DYING

- Dying with dignity movement that promotes the ability to meet death on
your teams.

Redefinition & Determination of DEATH

According to TIMBREZA

- Only man knows that he will die

- no person can die by proxy
- we die our own death.

3 Definitions of DEATH

CARDIAC ORIENTED

- Occurs when there is irreversible cessation of circulatory and respiratory

function.

WHOLE-BRAIN ORIENTED DEATH

- Irreversible loss of all functions and the entire brain.

HIGHER-BRAIN ORIENTED DEATH

- Irreversible loss of higher brain function (responsible for consciousness of

other functions considered crucial)

Issues on CARDIAC DEATH

- Determination and declaration of client’s death.

- Issues on organ transplantation.
- Cardiac arrest

- As to declaration of death the role of the physician is crucial, there are

countries who advocate organ transplants thus this can be an issue in cases
of declaration of death.

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 - Cardiac arrest once revived can be a problem in determining its prognosis.
- Sometimes after injury or long illness, the main organ of the body no longer
properly without your death care provider may tell you that these organs will
not repair themselves
- Medical Care to prolong life can keep you alive when these organs stop
working well.

INVIOLABILITY OF HUMAN LIFE

● an important tie between the ethics of religion and the ethics of law
● In religion and ethics – inviolability or sanctity of life refers to life as
sacred, holy and precious
The concept of inviolability is an important tie between the ethics of religion and
the ethics of law, as each seeks justification for its principles as based on both
purity and natural concept, as well as in universality of application. ×In religion and
ethics, the inviolability or sanctity of life is 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 ×The phrase sanctity of life refers to
the idea that human life is sacred, holy, and precious, argued mainly by the pro-life
side in political and moral debates over such controversial issues as abortion,
contraception, euthanasia, embryonic stem-cell research, and the "right to die" in
the United States, Canada, United Kingdom and other English-speaking countries.

● SANCITY OF LIFE- has been argued mainly by pro-life and moral debates
over issues like eunthanasia, abortion, embryonic stem-cell research and
the “right to die”
The phrase sanctity of life refers to the idea that human life is sacred, holy, and
precious, argued mainly by the pro-life side in political and moral debates over such
controversial issues as abortion, contraception, euthanasia, embryonic stem-cell
research, and the "right to die" in the United States, Canada, United Kingdom and
other English-speaking countries.

● LIFE-SUSTAINING TREATMENTS- A machine to help breathing

(ventilator)
- A machine to help your kidneys (dialysis)
- A tube in your stomach to provide food (nasogastric or gastrostomy tube)
- A tube into your vein to provide fluids and medicines (intravenous, IV tube)
- A tube or mask to supply oxygen.

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 ● COMMON DILEMMAS AT END OF LIFE- without and withdrawing the
medications
Code Status and Unilateral DNAR

- Artificial hydration & nutrition

Turning off ICD or much less commonly, pacemaker.

- Mechanical ventilation
When to stop chemo/XRT? – Mechanical Ventilation.

- Surrogate decision makers

Disagreement between patient/family & medical teams • Unique religious
preferences at end of life • Non-Beneficial or Futile medical interventions

- Disagreement between patient/family & medical teams

- Unique religious preferences at end of life
- Non-beneficial or futile medical interventions.

PROVIDENCE MODEL
✔ HONESTY in representing right professional practices and delivery of
health care.
✔ DEPENDABILITY in delivering care that benefits patients medically.
✔ FAIRNESS TO PATIENTS in their contexts
✔ ACCOUNTABILITY to legitimate interest of others in light of justice.

ETHICAL DECISION MAKING

⮚ - Clinical Integrity
⮚ - Beneficence
⮚ - Autonomy
⮚ - Justice
⮚ - Nonmaleficence

The moral issues EUNTANASIA and SUICIDE

Etymologically euthanasia is defined as “easy death” eu-easy;

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Thanatos” death
-more strictly it means painless, peaceful death, in an easy; painless way, of an
individual suffering from an incurable and agonizing disease
Popularly known as mercy killing.

CASES OF EUNTANASIA (Beauchamp and Walters (1978)

SELF ADMINISTERED EUNTANASIA (the client is asking to give them

medication for painless dying)/commission (Active/Positive): patient who will
deliberately terminate his life painlessly.
- Active euntanasia (positive) Wherein the terminally ill client who will
deliberately, directly terminate his life by employing painless methods. It is
therefore an act of commission so far voluntary and deliberate.

SELF ADMINISTERED EUNTHANASIA (the client is not taking medication for

in order to die)/ omission
(Passive/ Negative): allows oneself to die without taking any medicine or refusing
medical treatment.
- passive euthanasia (negative) euthanasia, in which one allows oneself to die
without taking any medicine or refusing medical treatment – It is in this act
of omission in so far one simply refuses anything to sustain life.

OTHER-ADMINISTERED EUNTHANASIA
1. active and voluntary
2. passive and voluntary
3. active and nonvoluntary
4. passive and nonvoluntary

EUNTANASIA:

VOLUNTARY: When Euntanasia is conducted with consent

Voluntary euthanasia is currently legal in Belgium, Luxembourg, The
Netherlands, Switzerland, and the states of Oregon and Washington in the
U.S.

NON-VOLUNTARY: when Euntanasia is conducted on a person who is

unable to consent due to their current health condition.

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 ACTIVE & VOLUNTARY: either physician, spouse or friend of the
patient will terminate the patient’s life upon request.

PASSIVE & VOLUNTARY: occur when the patient is simply allowed to

die.

ACTIVE & NONVOLUNTARY: decision of terminating the life of the

patient comes from the physician, spouse or friend.

PASSIVE & NONVOLUNTARY: occur when the patient is simply

allowed to die as requested by the family members.

DYSTHANASIA
- is a term generally used when a person is seen (to be kept alive artificially) in
condition where, otherwise, they cannot survive: sometimes for some sort of
ulterior (intentionally hidden/ future) motive.

ORTHOTHANASIA
- A normal or natural manner of death and dying. Sometimes used to denote
the deliberate stopping or artificial or heroic means of maintaining life. Also
called Passive Eunthanasia.

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PART 2

SUICIDE
- Defined as the direct, willful destruction of one’s life.
It is willful in so far deliberate, voluntary, and intentional; and it is destructive
insofar as the means of terminating one’s own life is more often than not,
violent, brutal, or very harsh.

Personal cause of Suicide

1. Misfortune and frustration on love and marriage.
2. Parental indifference towards one’s boyfriend or girlfriend.
3. In law problems.
4. Failure examination.
5. Loss honor and integrity
6. Nervous breakdown due to inability to cope with one’s problem.

Financial cause of Suicide

1. Poverty and impoverishment.
2. Great loss of money.

Social and Political cause of Suicide

1. Failed coup d’etat
2. Protest against man's inhumanity to man.

Application of BIOETHICAL THEORIES in Suicide.

- Think the Pros and Cons of suicide.
- How can we apply: Kant, Natural Law, and the Utilitarian viewpoints?

ADMINISTRATION OF DRUGS TO THE DYING

In medicine, specifically in end-of-life care, palliative sedation is the practice of

relieving distress in a terminally ill person in the last hours or days of a dying
patient's life, usually by means of a continuous intravenous or subcutaneous
infusion of a sedative drug, or by means of a specialized catheter designed to
provide comfortable and discreet administration of ongoing medications via the
rectal route.

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Palliative sedation is an option of last resort for patients whose symptoms cannot
be controlled by any other means.

It is not a form of euthanasia, as the goal of palliative sedation is to control

symptoms, rather than to shorten the patient's life.

ADVANCE DIRECTIVES
- Living will be a legal document used to state certain future health care
decisions only when the person becomes unable to make decisions and
choices on their own.
Durable power of attorney for health care/Medical power of attorney A durable
power of attorney for health care, is 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 Advance directives are legal documents that allow you to spell out your
decisions about end- of-life care ahead of time. They give you a way to tell your
wishes to family, friends, and health care professionals and to avoid confusion later
on.

END OF LIFE CARE PLAN or DNR (do not resuscitate)

- It includes palliative care.
- An illness that can’t be cured, based on the understanding that death is
inevitable.
Palliative care makes you as comfortable as possible, by managing your pain and
other distressing symptoms. It also involves psychological, social and spiritual
support for you and your family or careers.

WHEN DOES END OF LIFE CARE BEGIN?

- Advanced incurable illnesses, such as cancer, dementia, or motor neuron
disease are generally frail and have coexisting conditions that mean they are
expected to die within 12 months.
- Have existing conditions if they are at risk of dying from a sudden crisis in
their condition
- Have a life-threatening acute condition caused by a sudden catastrophic
event, such as an accident or stroke.

NURSING ROLE AND RESPONSIBILITY

- Treat people compassionately
- Listen to people

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 - Communicate clearly and sensitively
- Identify and meet the communication needs each individual
- Acknowledge pain and distress and take action.
- Recognize when someone may be entering the last few days and hours of life.
- Involve people in decisions about care and respect wishes.
- keep the person who is reaching the end of their life and those important to
them up to date with any changes in condition
- document a summary of conversations and decisions ¬seek further advice if
needed
- look after yourself and your colleagues and seek support if you need it
- Learning from complaints
- Care of the person choosing among alternatives in a manner consistent with
ethical principles.

In making ethical decisions, it is necessary to perceive and eliminate unethical

options and select the best ethical alternative. The process of making ethical
decisions requires:
•Commitment: The desire to do the right thing regardless of the cost
•Consciousness: The awareness to act consistently and apply moral convictions to
daily behavior
•Competency: The ability to collect and evaluate information, develop alternatives,
and foresee potential consequences and risks.

Good decisions are both ethical and effective:

•Ethical decisions generate and sustain trust; demonstrate respect, responsibility,

fairness and caring; and are consistent with good citizenship. These behaviors
provide a foundation for making better decisions by setting the ground rules for
our behavior.

•Effective decisions are effective if they accomplish what we want accomplished

and if they advance our purposes. The key to making effective decisions is to think
about choices in terms of their ability to accomplish our most important goals. This
means we have to understand the difference between immediate and short-term
goals and longer-range goals.

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