“Allahumma la sahla illama ja- with local communities to drive meaningful

‘altahu sahla anta taj ‘alu al hazana poverty alleviation and improve quality of
life. This is done through a range of programs
eza ma shi’ta sahal.”
that covers education, training and skills
“Oh Allah! Nothing is easy upgrade, healthcare and covers development.
except what you have made 3. Ecological – or environmental stewardship
easy. If you wish, you can can be defined as ‘the responsible use
make the difficult easy.” (including conservation of natural resources
in a way that takes full and balanced account
of the interest of society, future generations
D. OTHER RELEVANT ETHICAL
and other species, as well as of private needs
PRINCIPLES
and accepts significant answerability to
Stewardship – the responsible overseeing and society’
protection of something considered worth caring for 4. Biomedical – physicians have a
and preserving. responsibility to practice effective and
efficient health care and to use health care
Principle of Stewardship resources responsibly in practicing high-
Stewardship requires us to appreciate the two great value care. Parsimonious care that utilizes the
gifts that a wise and loving God has given: the earth, most efficient means to effectively diagnose
with all its natural resources, and our own human a condition and treat a patient puts the patient
nature with its biological, psychological, social and first but also respect the need to use resources
spiritual capacities. wisely and to help ensure that resources are
equitably available.
This principle is grounded in the presupposition that
God has absolute Dominion over creation, and that,
insofar as human beings are made in God's image and
likeness (Imago Dei), we have been given a limited
dominion over creation and are responsible for its
care.
The principle requires that the gifts of human life and
its natural environment be used with profound
respect for their intrinsic ends. The gifts of human
creativity especially should be used to cultivate
nature and environment, recognizing the limitations
The principles are basic and obvious morals truth
of our actual knowledge and the risks of destroying
that guide deliberation and action
these gifts.

1. PRINCIPLE OF DOUBLE EFFECT

The Stewardship in Health Care
An action that is good in itself that has two effects –
The theory of stewardship incorporates concepts of
an intended and otherwise not reasonably attainable
environmental and theological notions of practical
good effect, and an unintended yet foreseen evil
reasoning;
effect is valid and provided there is a due proportion
1. Personal stewardship – The responsibility to between the intended - good and the permitted evil.
take care of yourself and others using gifts
When there is a clash between the two universal
and talents.
norms of "do good" and “avoid evil," the question
2. Social Responsibility - Impacting the
arises as to whether the obligation to avoid evil
community in many ways. Working closely
requires one to abstain from a good action in order to R v Bodkin Adams (1957)
prevent a foreseen but merely permitted concomitant
GP acquitted of murder by administration of
evil effect. The answer is that one need not always
increasing doses of opiates to elderly patients.
abstain from a good action, that has foreseen bad
effects, depending on certain moral criteria Devlin, J (judge) introduced double effect
identified in the principle of double effect. doctrine: if the first purpose of medicine, the
restoration of health, could no longer be achieved,
Though five are listed here, some authors emphasize
there was still much for the doctor to do, and he was
only four basic moral criteria (the fifth listed here
entitled to do all that was proper and necessary to
further specifies the third criterion):
relieve pain and suffering even if the measures he
1. The object of the act must not be intrinsically took might incidentally shorten life"
contradictory to one's fundamental commitment to
2. PRINCIPLE OF LEGITIMATE
God and neighbor (including oneself), that is, it must
COOPERATION
be a good action judged by its moral object (in other
words, the action must not be intrinsically evil); Cooperation comes from the Latin word cum
which means "with" and operari which means "to
2 The direct intention of the agent must be to
work".
achieve the
COOPERATION is working with another in
beneficial effects and to avoid the foreseen harmful
the performance of an action.
effects as far as possible, that is, one must only
indirectly intend the harm; Various Degree of Cooperation – The degrees of
cooperation may vary according to the gravity or
3. The foreseen beneficial effects must not be
essentiality of the shared act in the performance of an
achieved by the means of the foreseen harmful
evil action.
effects, and no other means of achieving those effects
are available 1. Formal Cooperation – occurs when a person
or organization freely participates in the
4. The foreseen beneficial effects must be equal to or
action of a principal agent or shares in the
greater than the foreseen harmful effects
agent’s intention, either for its own sake or as
(the proportionate judgment);
a means to some other goal.
5. The beneficial effects must follow from the action
An anesthetist who adopts the same intention as
at least as immediately as do the harmful effects.
the surgeon in an operation to perform a
Double Effect contraceptive sterilization formally cooperates in
the evil. Formal cooperation in the sinful act of
Some interventions undertaken by physicians
another is always wrong and the cooperator is
can create a positive outcome while unintentionally
equally guilty of the act as the principal actor.
doing foreseeable harm. The combination of these
two circumstances is known as the "double effect". For example, if I counsel a young girl to have an
abortion, I am formally cooperating in the evil of
A commonly cited example of this
abortion.
phenomenon is the use of morphine in the dying
patient. 2. Mediate Material Cooperation
Such use of morphine can ease the pain and occurs when the cooperator participates in
suffering of the patient, while simultaneously circumstances that are not essential to the
hastening the demise of the patient through commission of an action, such that the action could
suppression of the respiratory system. occur even without this cooperation. Mediate
material cooperation in an immoral act might be
Legal recognition of doctrine of double effect
justifiable wider three basic conditions:
 If there is proportionately serious reason for c. If the material cooperation is proximate, a
the cooperation (i.e. for the sake of protecting an reason sufficiently graver should exist so as
important good or for avoiding a worse harm): the to be morally excused without which evil is
graver the evil the more serious a reason required for incurred.
the cooperation 3. Principle of the Common Good
In general, the common good consists of all
The importance of the reason for cooperation
the conditions of society and the goods and
must be proportionate to the causal proximity of the
secured by those conditions, which allow
cooperator's action to the action of the principal
individuals to achieve human and spiritual
agent (the distinction between proximate and
flourishing.
remote);
The danger of scandal (Le., leading others This teaching is encapsulated in the
into doing evil, leading others into error, or spreading principle of the common good and it
contusion) must be avoided. In the context of corollary principle of subsidiarity. According
healthcare, the provision or omission of some to this understanding, the principle of the
services might be scandalous common good has three essential elements:
1. Respect for persons
3. Immediate Material Cooperation
Occurs when one actually performs the immoral
action in cooperation with another.
Thus, in the abortion operation, if the surgeon and
assistant are actually aborting the fetus, the
cooperation of the assistant is said to be immediate
material cooperation.
Exemption can be had 'in the case of theft when one
is force at gunpoint to carry the burden. The one
forced however is not a thief — because of the
definition of theft since with regard to the person
forced into assisting by threat of death, the owner's
unwillingness to have his properly taken would not
be reasonable. As regard to the real thief, it would 2. Social welfare
be. 3. Peace and security.

4. Direct and Indirect Cooperation All three of these elements entail

provision of heath care in some wat as an
Direct Cooperation – consists of the direct essential element of the common good
participation in the performance of an evil act.
The only directly cooperating gets involved by This conception of the common good
openly and straightforwardly taking part in the requires the peace and security that
practice of an evil action. accompanies a just social order. Public
authority, then, should be used to ensure, by
Moral Rules Governing Cooperation morally acceptable means, the security of the
society and its individual members.
a. No one should formally and directly
cooperate in the performance of an evil 4. PRINCIPLES OF SUBSIDIARY
action.
b. If a reason sufficiently grave exists, material The principle of subsidiarity is a kind of
cooperation in the performance of an evil sociological discipline adhered to and
action may be morally excused.
 advocated by the church. Its moral way that the organism becomes no longer
implication is embedded in its meaning. basically whole.
It means that what an individual. lower or
Is an action by which an organic function/the
smaller group
use of a member of the body is intentionally
can achieve within his/her or its capacity
destroyed either partially or wholly.
should not be taken away and transmitted to
the custody 'and performance of a higher or Types
bigger group.
1. Direct - Willed in itself, as end or as means,
The principle implies that, when a intended and caused intrinsically wrong. Offends
decision is to be made, we should identify the human dignity. Individual does not have the right to
most appropriate forum and level of decision mutilate himself, much less does society.
making, and how best and to what degree
2. Indirect (Therapeutic) - or Licit - is an act
those individuals most affected should
of good stewardship of the body; necessary for the
participate in the decision-making process
survival of the patient or to free him of proportional
2. Principles of Integrity and Subsidiary
2. Sterilization – a medical or surgical intervention,
The whole implies the existence of its which causes a patient incapacity of generation.
parts. The existence of its parts indicates the
1. Indirect (Therapeutic) - Inevitably required for the
existence of the whole.
survival and health
Parts as such should continuously be
of a person, sexual organs, integrating parts
connected with the whole of which they are
which must yield to the good of the whole.
parts without which they cease to be.
Licit if:
TOTALITY AND INTEGRITY AS APPLIED
a.) Sickness is grave, certainly diagnosed and
TO THE FOLLOWING CONDITIONS:
definitive that it offsets the evils of
1.Surgery – for the food of human body which is sterilization.
directly opposed to mutilation which is a destruction
b.) It is necessary because it is the only
of the body.
possibly effective remedy.
The principle of totality aims to preserve life
c.) Exclusively curative. Intention is
in its totality, in its whole and sometimes that may
important.
mean sacrificing a part of the body.
2. Direct - Immediate effect is to render procreation
More concretely – examples maybe
impossible. (illegal)
amputations, cancerous tissue removal, organ
removal Types:
When the preservation of the organ may cause grave a.) Eugenics - Seeking to avoid the transmission of
injury hereditary defects.
When the removal means avoiding more serious b.) Hedonistic - Evade the complications and
complications responsibilities of procreation without giving up the
sexual pleasure.
When the removal will diminish the risk of death.
c.) Demographic - To control the birth rate.
1. Mutilation -Destruction of member, organ/
part of the body (organic) or the suppression d.) Preventive - Render pregnancy impossible which
of a physical function (functional) in such a might aggravate the sickness that already exist.
PRESERVATION OF BODILY FUNCTIONAL the whole person) or is too burdensome for the
INTEGRITY patient or others, i.e., the burdens or risks are
disproportionate to or outweigh the expected benefits
Organ transplants are justified when the functional
of the treatment (use of ventilator to assist breathing
integrity of the donor is maintained.
in a coma patient
3. Organ Donation
CARE must be taken not to confuse the terms
- A person may will to dispose of his body and to "ordinary care" and "ordinary means." While patients
destine it to ends that are useful, morally may forego treatments that are disproportionate or
irreproachable, and even noble among them, the extraordinary mauls, there is always an obligation to
desire to aid the sick and suffering. provide ordinary care due to the sick person, that is,
to provide non-medical nursing interventions.
Criteria:
4. Principles of Personalized Sexuality
1. There's a serious need on the part of the recipient
that cannot be fulfilled in any other way. Is based on the understanding of sexuality as
one of the basic traits of the human person and must
2. The functional integrity of the donor with a human be developed in ways consistent with enhancing
person will not be impaired even though anatomical human dignity
integrity may suffer.
This element of human character often leads
3. The risk taken by the donor as an act of charity is to a loss of human dignity and an inability to prom
proportionate to the good resulting to the recipient. the truly fulfilling goals of human life
4. The donor's consent is free and informed.
5. The recipients for the scarce organs are selected The Principles of Personalized Sexuality may be
justly stated as follows:
3. Principles of Proportionate and 1. The gift of human sexuality must be used in
Disproportionate Means marriage in keeping with its intrinsic,
Often used synonymously with the term indivisible, specifically human teleology
“ordinary/extraordinary means” since the two sets of 2. It should be loving, bodily, pleasurable
terms were equated in the 1980 Vatican Declaration expression of the complimentary, permanent
on Euthanasia. self-giving of a man and woman to each
other, which is open to fruition the
The Principle holds that one is obligated to perpetuation and expansion of this personal
preserve his or her own life by making use of communication through the family they beget
ordinary means, but is under no obligation to use and educate.
extraordinary means. In other words, when a medical
intervention “mean” is proportionate, one has a Bioethics and its Application in Various Health Care
general obligation – all things considered to accept Situations
the treatment. A. SEXUALITY & HUMAN REPRODUCTION
Proportionate Means is a treatment that, in the The working definition of sexuality is: "...a
given circumtances, offers a reasonable hope of central aspect of being human throughout life
benefit and is not too burden some for the patient or encompasses sex, gender identities and roles, sexual
others (IV FLUIDS, parental Injections) orientation, eroticism, pleasure, intimacy and
Disproportionate Means is any treatment that, in reproduction (WHO, 2006a)
the given circumstances, either offers no reasonable Human reproduction is essential for the
hope of benefit (taking into account the well-being of continuance of the human species. Thus, God's
design for the continuance of the human race is stated Refers to a direct and positive method preventing
biblically when He said 'Be fruitful and conception before, during or after the act of sexual
intercourse
2. Marriage
Is it Moral ?
Fundamentals of Marriage
Since time immemorial, the church has
Marriage exists to bring a man and a woman
strongly and forcefully maintained - amidst
together as husband and wife to be father and mother
vehement criticisms from different sectors in the
to any children their union produces.
society - that contraception, in its various unnatural
It is based on the anthropological truth that methods counter to the true standards of moral
men and women are different and complementary, conduct in marital act
the biological fact that reproduction depends on a
Contraception is evil not because the Church
man and a woman, and the social reality that children
prohibits it, rather the church prohibits contraception
need both a mother and a father.
because it is evil
Sex Outside Marriage
The evil of contraception resides in it
In the Catholic tradition, moral sexual defiance of the will of God indicated in the law of
activity institutionalized within the confines of nature.. Procreation of life
marriage and procreation, and sexual morality is
Dignity in death and dying
marital morality. Official church teaching rules out
any sort of sexual activity outside the marriage Dignity – 2 Latin words dignitus “merit” dignus
0multiply and fill the earth." “worth”. The international council for nurses code of
ethics 2012 instructs that the observance of dignity
Homosexual
should not be limited by the individuals age,
A person sexually attracted to persons of the color,culture….
same sex. Homosexuals include males (gays) and
2 factors in preserving of dignity
females (lesbians)
1. Promoting Self Respect
According to tile traditional interpretation of
2. Treating the patient with respect.
natural law, homosexual acts are not ordered toward
those specific ends and so they are deemed Euthanasia & Assisted Suicide
"disordered." Thus, "under no circumstances can  Orthothanasia – letting the incurably
they be approved," diseased person “die his own death’ while
making no extra efforts to prolong his life.
For example, an acorn is quite obviously  Dysthanasia – is the term for useless
"ordered" toward becoming an oak tree. A child is treatment which does not benefit the patient.
"ordered" toward becoming an adult. Likewise,  Passive Euthanasia (omission) – refraining
every act is judged according to whether it is properly of any medical treatment aimed at retarding
oriented toward its proper end. In terms of sexuality, death
all sex is "ordered" toward what are called the  Active Euthanasia (Commission) –
"affective" (love) and terminating a person’s life in a painless way,
"generative" (having children) ends, within the at his request & with the intention to prevent
context of marriage. person from suffering
CONTRACEPTION
 Withholding treatment is an act of omission
morality & ethico-moral responsibility of the while withdrawing treatment is an act of
Nurse commission.
 Treatment is not only in terms of
medications but also utilization of
 equipment, intubation, ventilators and
feeding tubes
Suicide – is the direct willful destruction of one’s
own life.
Advance Directives
 Definition: an advance declaration by a
person of treatment preferences if he or she
is unable to communicate his or her wishes.
 Instructions for the future

 Living Will o Document that tells you what

I want in the future in case I cannot make a
decision anymore
o Both oral and written are acceptable
in the court of law – needs to be
proved

 Durable Power of Attorney o

Designates somebody else to make the
decision for me in case in the future I cannot
make a decision anymore
o Authorization letter o Specific and
with proof
 Health Care Proxy