Conditions for Ethical Decision Making

8/13/2019 Conditions for Ethical Decision Making

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CONDITIONS FOR

ETHICAL DECISIONMAKING

ABORTIONIs the termination of pregnancy by

the removal or expulsion of anembryo or fetus from the uterus,resulting in or caused by its death.

ABORTIONIt is a method of birth control in which

conception is terminated rather than

prevented.

In Ancient Greece, Plato and Aristotlerecommended abortion in order toavoid excess population in small Greek

City states.

abortionExpulsion of a fetus from the mother’s womb before it is viable.

Normally, a child is considered to be

viable at about the 28th

week or towardthe end of the 7th month (at least thefetus born during this period has about

a 10% chance of survival)

“Sa dalagang hindi dinadatnan,

pamparegla ang kailangan.”

“pamparegla sa aleng may asawa,upang hindi mabuking sa misternya, pagdating mula Saudi Arabia.”

TYPES OF ABORTION

1. Natural abortionOr the expulsion of the fetus through

natural or accidental causes.

This is also known as SPONTANEOUS or accidental abortion.

MISCARRIAGE

2. Direct or intentional abortionRefers to the deliberately

induced expulsion of a livingfetus before it has become viable

3. Therapeutic abortionThe deliberately induced

expulsion of a living fetus inorder to save the mother fromthe danger of death brought on

by pregnancy.

4. Eugenic abortionThis is recommended in cases where

certain defects are discovered in the

developing fetus.

It is termed “eugenic” because it ismeant to get rid of abnormal babies(that is, children with birth defects and

deformities)

5. Indirect abortionIn this case, the removal of the fetus

occurs as a secondary effect of a

legitimate or licit action, which is thedirect and primary object of theintention.

An abortion can occur spontaneouslydue to complications during pregnancy

or can be induced.

Abortion as a term is mostcommonly referred to the inducedabortion of a human pregnancy,

while spontaneous abortions are

usually termed miscarriages.

EUTHANASIAGreek term “thanatus”- the act of

practice of permitting the death ofa hopeless sick or injuredindividuals in a relatively painless

way for reasons of mercy. It iscommonly called merciful killing torelieve suffering.

euthanasiaEtymologically, euthanasia

means “easy death” (from theGreek word eu – “easy” andthanatus – “death”)

More strictly, it means painless,

peaceful death.It is popularly known as “mercy

killing”

Cases of euthanasia may be

grouped into:SELF-ADMINISTERED

OTHER-ADMINISTERED

ACTIVE (positive) euthanasia- in which

terminally ill patient will deliberately, directly

terminate his life by employing painlessmethods– it is an act of commission insofar asit is voluntary and deliberate.

PASSIVE (negative) euthanasia- in which oneallows oneself to die without taking anymedicine or by refusing medical treatment– it

is an act of omission insofar as one simplyrefuses to take anything to sustain life.

Other administered A. active and voluntary euthanasia

Is one in which either a physician, spouse

or a friend of the patient will terminatethe latter’s life upon the latter’s request. Itis voluntary insofar as it is requested by

the patient. It is active insofar as somepositive mean’s is used to terminate thepatient’s life.

B. passive and voluntary euthanasia

Is one in which a terminally ill patient is

simply allowed to die by the physician,spouse, or an immediate relative, uponthe patient’s request. It is passive insofar

as no positive method is employed. Thepatient is merely permitted to pass away.It is voluntary insofar as this is done upon

the patient’s request.

C. active and nonvoluntary euthanasia

Occurs when it is the physician, spouse,close friend or relative who decides thatthe life of the terminally ill patient shouldbe terminated. It is active insofar as somepositive method is used to terminate the

patient’s life; it is nonvoluntary insofar asthe termination of the patient’s life isdecided by an individual other than the

patient.

D. passive and nonvoluntary euthanasia

Is one in which a terminally ill patient is simply

allowed to die, as requested by immediate familymembers, (spouse or parents) or the attendingphysician. It is passive in as much as no positivemeans is employed to end the patient’s life; it is

nonvoluntary insofar as other persons make themoral decision to terminate the patient’s life.

PRINCIPLE OF

INFORMED CONSENT

Principle of informed consent It is the right and responsibility of every competent

individual to advance his or her own welfare. Thisright and responsibility is exercised by freely and

voluntarily consenting or refusing consent torecommended medical procedures, based on asufficient knowledge of the benefits, burdens, and

risks involved.

INFORMED CONSENT A process by which patients are

informed of the possible outcomes,alternatives, and risks of treatmentand required to give their consent

freely.

In health care, INFORMED CONSENT refers to the patient’s deliberate and

voluntary acceptance of a health careprocedure which presupposes sufficientdisclosure of the nature and goal of the

procedure; its possible side-effects, risks,benefits; and the available medical options.

The ability to give informed consent depends on:

1. adequate disclosure of information

2. patient freedom of choice

3. patient comprehension ofinformation; and

4. patient capacity for decision-making

The disclosure of information The consent that is given by the patient is an

informed one. It is the elicited act of his will whichhe may not be able to do so without the light ofknowledge in the mind obtained from thedisclosure of information.

Meaning, the patient has prior knowledge about

the medical procedure, risks and benefits, and theavailable options for him to enable his will to makedecisions resulting to the provision of his consent.

The decision his will makes to give hisconsent is limited by what his mind

knows about the said information.Thus, the amount of knowledge upon

which the will depends its decision-

making to consent primarily relies onthe extent of information given.

In other words, the more information,the more knowledge is obtained; the

more knowledge is obtained, the freerthe will to tend to elicit consent.

The opposite happens if the amount ofinformation given is too small orunduly insufficient.

Usual standards of adequate

disclosure of information:a. The disclosure standard based on the

traditional practices of the professional

community. It refers to what is generallyacceptable to medical practitioners inmatters of disclosing information. This can

be judged by common sense among them.Ex: expected risks are told of a required

procedure.

b. The reasonable standard based on what ahypothetical reasonable person would judge

a pertinent to the decision-making process.Ex: a conscious patient would want to be

informed about some alternative procedures

before he finally makes his choices.

c. The subjective standard based on whata particular patient needs to know.

Ex: a prominent patient who asks aboutthe nature of a more scientificallyadvanced procedure other than whatcan usually be done.

By meeting t ese our

By meeting t ese ourrequirements, three necessary

conditions are satisfied: 1. that the individual’s decision is voluntary

2. that this decision is made with an

appropriate understanding of thecircumstances; and

3. that the patient’s choice is deliberate in sofar as the patient has carefully considered all

of the expected benefits, burdens, risks andreasonable alternatives.

Legally, adequate disclosure includesinformation concerning the following:

A. diagnosisB. nature and purpose of treatment

C. risks of treatment; and

D. Treatment alternatives

The voluntary nature of informed

consentBasically, every informed consent is voluntary in nature.

It is the product of the patient’s decision which is within the power of his will. As a voluntary act, informed consent

presupposes the use of the patient’sknowledge and freedom without which itcannot be voluntary thereby destroying itsnature.

patient’s competence

Refers to the ability of the patient to make choicesand decisions on the information disclosed. It may

vary from one case to another under specificcircumstances. It is also possible that patient’scompetence may be impaired or completely absentbecause of the gravity of his pathologic condition.

Consequently, he may not be able to give thenecessary informed consent.

FOUR MAJOR ELEMENTS OF

INFORMED CONSENT

1. COMPETENCEThis refers to a patient’s capacity for

decision-making.

2. disclosureThis refers to the content of what a

patient is told or informed about

during the consent negotiation.

3. comprehensionThis refers to whether the information

given has been understood.

Other forms of consent:CONSENT BY PRESUMPTION- this is

reasonably presumed to be present in

the subsequent employment and seriesof procedures as they are aligned withthe primary procedure to which explicit

consent is expressed.

Ex: though it is not utterly expressed,consent to perineal flushing is

reasonably presumed that is done afterthe patient is medically assisted fordelivery to which she gives explicit

consent.

Another form of consent by presumption isattributed to the patient who, in his current

biological condition, cannot utterlyarticulate consent. The judgment ofprudence and reason takes a sufficientground for the consent of the mostappropriate medical procedure to serve thebest interest of the patient.

Consent by proxyThis is done when the patient is not capable

of giving informed consent and is

legitimately represented by a competentsurrogate who acts on his behalf. Thepatient may either be unconscious, insane,or a minor/child who is out of reason or notat the age of reason. The competence of therepresentative primarily resides in hismanifested motivation to serve the best

interest of the patient.

Ex: a febrile baby is given an antipyreticinjection at the consent of his mother.

TRUTHFULNESSIs the state or condition of being

truthful. To be truthful is to be

communicative of truth in its simpleand genuine character.

Moral obligations to truthfulness As a general rule, every human person who

has the use of reason is morally obliged to

be truthful and not to distort the truth.His rational faculty of intelligence that

enables him to have an intrinsic desire and

propensity for truth is that which negatesany preference for anything contrary tobeing truthful.

LIEIs the distortion and perversion of whatis in the mind, characterized by the

malice of deception which causes graveharm. The presence of deception inlying implies one’s lawful basis of

knowing the truth to which he has aright. Hence, a lie is an untruth told toone who has a right to the truth.

In health care practice, health professionals aremorally responsible for the truthfulness they ought toaccord their patients and their patient’s relatives.

A lie in its given definition should not be among themedical and health care standards to be observed bythe health care practitioners whose profession bynature is associated with public trust and confidence.

Is it possible to withhold the truth oreven state what seems untrue without

the element of lying thereby beingmorally excused?

This question has to be properlyqualified. It is also in harmony with the

dictates of reason that communicationof truth along with its simplicity andgenuineness is couples with prudence

and discretion.

prudence Is that human quality which enables one to

have a good grasp of the most appropriate

means to take so as to achieve an end in agiven situation. It may be characterized bycarefulness and good judgment, on onehand, and cautious response to stimuli andexactness, on the other. In short, it providesreasonable balance between falling too shortor going too far.

discretionIs a human quality of making a correct judgment on what is right and proper

to be done according to propriety andreason under certain circumstances.

Conditions for the concealment of

the truth:The truth can be concealed by mere

refusal of disclosure or by a seemingly

untrue statement when one or any ofthe following conditions is evident:

The inquiring person has no right to it.

One’s right to certain knowledge that can

be obtained from another through inquirymay not be in force under allcircumstances. It has to be weighed down

with respect to others’ rights. Thus, theright to knowledge may cease when it is tobe employed at the destruction of theothers rights.

Ex: a suspiciously lookingindividual inquires at the nurse’s

station about the location of apatient who turns out to be his

target of assassination.

The duty withhold it is greater than the dutyto reveal it.

This is in place when the truth is sealed with secrecy whose exposition may causeunnecessary harm and undue damage

comprising acts against justice andcharity.

Ex: a health care practitioner is legallyand morally obliged to observe

professional secrecy regarding hispatient’s health information acquiredby the nature of his profession.

There is a reason sufficiently gravecalling for the withholding of the truth.

A reason is sufficiently grave when itinvolves higher moral principle or valuethat is at stake including commongood, peace, etc.

Ex: sensing that a patient’s relative has thetendency to be hysterical or violent, which

may cause disorder in the hospital, theattending physician withholds the unfoldingof truth about the terminal condition of thepatient.

Mental reservationRefers to the ambiguous and veiled

statement to the inquirer who is not

entitled to the truth for having no rightto it.

In health care, the patient, by reason of inevitablecircumstances, at least, at a certain moment, may notbe able to invoke his rights to the truth about his

health condition. This stems from the patient’sinability to bear the truthful information by reason of which he loses his right and is superseded by a greaterprinciple that values his protection from undue harm

and damage.

Ex: a patient with terminal cancer is in danger ofdeath. Though aware that his condition is fatal, hedoes not know that he is dying soon. Despite the

possibility of mental breakdown out of truthfulexposition of his proximate death, the patient ispolitely and caringly told about it so that he may beable to prepare himself to face God by going to

confession, atoning his sins, and others. He is justgiven the necessary medical treatment for his mentalbreakdown.

Professional secrecy and privacy Since it is a revelation of what is in the mind,

truthfulness can also be considered a manifestation ofone’s innermost depth in his way of thinking,

speaking, and acting as truthful person. Tempered with prudence and discretion, being

truthful bridges all gaps, settles differences, repairs wounds and eliminates divisiveness among people for

human growth in peace and harmony.

Professional secrecyPertains to the confidentiality and privacy of

facts about the personal and pathologic

circumstances of the patient known to thehealth care practitioners through hissubmission to health care processes.

Can secrets be broken and

disclosed?

Yes, provided the necessaryconditions are met:

Conditions for the breaking of

gprofessional secrecy in health

1. The patient practically allows the

disclosure or is obliged to do so.Ex: upon realizing that he needs a widehorizon of assistance, an AIDSpatient makes up his mind to permitthe disclosure of his condition.

2. the secret is exposed by others and becomes apublic knowledge. In which case, it ceases to be asecret.

Ex: the information about the pre-maritalpregnancy of a bachelor-woman which issupposed to be a secret spreads out because of its

disclosure by others.

3. the concealment of a secretendangers a greater good which is of

higher value. At this juncture, thesecret itself ceases to be.

Ex: an AIDS patient who, in his severely

depressed frame of mind, escapes andthreatens to infect others.

Family’s right to information By reason of the natural bondage of kinship, the

immediate responsible members of the family mayalso have the right to information regarding their

patient. Moreover, they are affected, in significant ways, by the patient’s illness. Any ignorance aboutit may give rise to unnecessary damages as intransmission of infection in case of communicabledisease, and the likes.

Organ transplantation is the moving of an organ from one body to another, orfrom a donor site on the patient's own body, for thepurpose of replacing the recipient's damaged or absent

organ. The emerging field of Regenerative medicine isallowing scientists and engineers to create organs to bere-grown from the patient's own cells (stem cells, orcells extracted from the failing organs). Organs and/ortissues that are transplanted within the same person's

body are called autografts. Transplants that areperformed between two subjects of the same speciesare called allografts. Allografts can either be from aliving or cadaveric source.

Types of transplant

Autograft

Transplant of tissue to the same person. Sometimesthis is done with surplus tissue, or tissue that canregenerate, or tissues more desperately needed

elsewhere (examples include skin grafts, veinextraction for CABG, etc.) Sometimes an autograft isdone to remove the tissue and then treat it or theperson, before returning it (examples include stem cell

autograft and storing blood in advance of surgery ).

Allograft

An allograft is a transplant of an organ or tissuebetween two genetically non-identical members of thesame species. Most human tissue and organ

transplants are allografts. Due to the genetic differencebetween the organ and the recipient, the recipient'simmune system will identify the organ as foreign andattempt to destroy it, causing transplant rejection. Toprevent this, the organ recipient must take

immunosuppressants. This dramatically affects theentire immune system, making the body vulnerable topathogens.

Isograft

A subset of allografts in which organs or tissues aretransplanted from a donor to a genetically identicalrecipient (such as an identical twin). Isografts are

differentiated from other types of transplants because while they are anatomically identical to allografts, theydon't trigger an immune response.

enogra ant l t ti

xenotransplantation

A transplant of organs or tissue from one species toanother. An example are porcine heart valvetransplants, which are quite common and successful.

Another example is attempted piscine-primate (fish tonon-human primate) transplant of islet (i.e. pancreatic or insular tissue) tissue. The latter research study wasintended to pave the way for potential human use, ifsuccessful. However, xenotransplantion is often an

extremely dangerous type of transplant because of theincreased risk of non-compatibility, rejection, anddisease carried in the tissue. This is a very serious typeof transplant.

S lit t l t

Split transplants

Sometimes a deceased-donor organ, usually a liver,may be divided between two recipients, especially anadult and a child. This is not usually a preferred option

because the transplantation of a whole organ is moresuccessful.

D i t l t

Domino transplants

This operation is usually performed on patients with cysticfibrosis because both lungs need to be replaced and it is atechnically easier operation to replace the heart and lungsat the same time. As the recipient's native heart is usually

healthy, it can be transplanted into someone else needing aheart transplant. That term is also used for a special formof liver transplant in which the recipient suffers fromfamilial amyloidotic polyneuropathy , a disease where theliver slowly produces a protein that damages other organs.This patient's liver can be transplanted into an olderpatient who is likely to die from other causes before aproblem arises.

WHAT IS CLONING?

Cloning is the creation of an organism that is an exactgenetic copy of another. This means that every singlebit of DNA is the same between the two!

H i l i d ?

How is cloning done?

You may have first heard of cloning when Dolly theSheep showed up on the scene in 1997. Cloningtechnologies have been around for much longer than

Dolly, though.

1 A tifi i l E b T i i

1. Artificial Embryo Twinning

Artificial embryo twinning is the relatively low-tech version of cloning. As the name suggests, thistechnology mimics the natural process of creating

identical twins.

2 S ti C ll N l T f

2. Somatic Cell Nuclear Transfer

Somatic cell nuclear transfer, (SCNT) uses a differentapproach than artificial embryo twinning, but itproduces the same result: an exact clone, or genetic

copy, of an individual. This was the method used tocreate Dolly the Sheep.

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