Bioethics Reviewer Lesson 4 (week 4)

Principle of Stewardship

 Stewardship requires us to appreciate the two great gifts that a wise and loving God has given: the earth,
with all its natural resources and our own human nature, with its biological, psychological, social, and
spiritual capcities.

 This principle is grounded in the presupposition that God has absolute Dominion over creation, and that, in
so far as human beings are made in God's image and likeness.

 The principle of stewardship includes but is not reducible to concern for scare resources, rather, it also
implies a responsibility to see that the mission of Catholic health care is carried out as ministry with its
particular commitment to human dignity and the common good.

 Nurse stewards hold the potential to inform meaningful change in nursing practice, owing to their capacity to
act upon their character qualities, including self-discipline and courage as well as engage in practical
reasoning, by which the intrinsic value or good of a situation is preserved and promoted

Principle of Totality and Integrity

Totality

 The principle of totality upholds the unity of the whole because the whole is greater than its
parts.

"Each part only exists for the good of the whole"

"Totality" refers to the duty to preserve intact the physical component to the integrated bodily and spiritual
nature of humana life, whereby every part of the human body "exists for the sake of the whole as the
imperfect for the sake of the perfect".

 This principle says that an individual has a right to dispose of his or her organs or destroy their capacity to
function only to the extent that the general well-being of the whole body demands it

 Thus, it is clear yhat we have a natural obligation to preserve our lives, but, by the Roman Catholic view, we
also have a duty to preserve the integrity of our bodies.

o This duty is based on the belief that each of our organs was designed by God to play a role in maintaining
the functional integrity of our bodies- that each has a place in the divine plan. As we are the custodians of
our bodies, not their owners, it is our care for them as a trust

o The principle of totality has implications for a great number of medical procedures.

o Strictly speaking, even cosmetic surgery is morally right only when it required to maintain or ensure the
normal functioning of the rest of the body

o These principles dictate that the well-being of the whole person must be taken into account in deciding about
any therapeutic intervention or use of technology
 o "Integrity" → "preserve a view of the whole human person in which the values of the intellect, will,
conscience, and fraternity are preeminent

Consider the entire person when deciding which therapies, medications or procedures a patient should
receive.

The Responsibilities of Nurses

Theorectical Views

 Nurse's primary responsibility is the patient. Nurses have the legal responsibilty to use knowledge and skills
to protect patients but ultimately bear the moral and ethical resposibility to serve as patient advocates to
prevent any violation of patient's right. Therefore, nurses remain to be vigilant, attentive, sensitive, and
responsive to the patient's and family needs

Personal Views

 Though the nuse's responsibilty is the patient, it changes depending on or according to the work situation
and the nursing role

What is Nursing Role?

Nurses have different rules. Though the some roles are dependent o the setting and responsibility, there are
common roles of nurses regardless. The traditional, common, and most essential role of nurses, with high
regards to the moral and ethical viewpoints, are:

1. Care provider: provides direct care to patients in a respecting, nurturing, comforting, caring and
knowledgeable way.

2. Educator: increase patient knwoledge through information dissemination, encouraging healthy

lifestyles and practices and compliance to care

3. Counselor: Promotes the patient's ability to make sound medical decisions, assists in developing
new attitudes, feeling,and behaviors, and helps patients initiate action to improve health care or to
change decisions or activities which are against the interests or wishes of the patient.

4. Change agent: Takes the necessary actions to educate and initiate change for the well-being and
the health of the society.

5. Researcher: Takes the initiative to examine and explore on things affecting the sensitive health
care issues, thereby promotig the health system and protecting the people's rights of better health.

The Nursing Code of Ethics

 Practice with compassion and respect

 Primary commitment is the patient
  Advocates for the health of patients
 Shows responsibilty and accountability for nursing practice
 Owes same duties to self as others
 Partcipates in improving health care environments
 Participates in advancement of the profession
 Colloborates with others to accomplish the needs of patients
 Respects the nursing profession and maitains integrity of the practice

What is MUTILATION?

 Any lessening of the integrity of the human body

1. Major Mutilation: renders individual unfit for natural function.

Ex: Sterilization, removal of tongue. Etc.

2. Minor Mutilation: Does not destroy its function

Ex: removal of tonsils or appendix

Principle of totality: All the part of the body are ordained for the good of the whole entity. Therefore, there is no moral
violation when it is necessary to destroy a part for the good of the whole.

Moral and Immoral Mutilation

Moral:

1. Surgical removal of a healthy organ to arrest disease in another organ may be allowed
Two conditions:

1. Must cause a threat to the entirebody, and such harm cannot be avoided except by a mutilation.

Immoral:
1. The removal of a healthy organ usaully immoral:

Ex: direct sterilization of a male or female

STERILIZATION

o Positive use of artificial methods

o Cutting of the sexula capacity in a man and woman
o Usually done surgically

Types: (according to willingness)

o Voluntary
o Involuntary

Types: (according to purpose or ends)

 Therapeutic
 Contraceptive
 Eugenic
 Social
  Punitive

Therapeutic Sterilization

o Removal of part or all of the reproductive organ

o To save ones life or promote bodily integrity
o Principle of totlity (under natural law ethics)

Contraceptive Sterilization

Justification:

1. serious illness of either husband of wife

- TB, epileptics, syphilis

2. Probability of genetic abnormality

-Carrier of defective gene

3. Financial burden
4. Child-bearing puts one's health

Eugenic and Social Sterilization

o Purpose of hindering the conception of undesirable and physically ormentally unfit offspring
o Social engineering
o Society free from individulas afflicted with social diseases
o Grave mentals defects
o Idiots
o Imbeciles
o Morons
o Insane
o Carriers of congenital defective genes

Pumitive Sterilization

o Done as punishment for crime or antisocial behavior

o Catholic theologians defended this under the double effect principle
o The sterilization is not "direct" since the primary and intended effect is punishment and the contraceptive
effect is therefore 'indirect" or secondary.

Direct Sterilization

o 1. Immediate purpose is the making of reproduction impossible.

EX: hysterectomy (removal of uterus); ligation or cutting of the fallopian tubes, ligation pf the vas deferens
(vasectomy), removal of the ovaries or the testes

Indirect Sterilization:

o Occurs as a necessary but unitended consequence of a medical procedure.

o EX: Condition exist and the operation is performed to save life or health of mother

Preservation of Bodily functional Integrity

 o The principle of totality aims to preserve life in its totality, in its whole and sometimes that may mean
sacrificing a part of the body.

o More concretely - examples may be amputaions, cancerous tissues removal, organ removal.

On the removal of Healthy organs:

1. ) when the preservation of the organ may cause grave injury

2. ) When the removal means avoiding more serious complications
3. ) When the removal will diminish the risk of death

o This principle however may not be applied to the generative organs (sterilization) when the health of the
individual is not at stake. Here the end of preserving life is not present
o Organ transplant are permisible as long as the life of the donor is not placed at risk.

Organ Donation

o The gift of an organ donated by a human being to another human being

o Giving of tissue or organ by a perso to another person or institution

Physicians determining that the death of the potential donor has occured, should not be directly involved in organ
removal from the donor and subsequent transplantation procedures, or be responsible for the care of potential
recipients of such organs.

Organs for transplantation should be removed preferably from the bodies of deceased persons

 Adult living persons may donate organs, but in general such donors should be genetically related to the
recipients

 An organ may be removed from the body of an adult living donor for the purpose of transplantation if the
donor gives free consent

 No organ should be removed from the body of a living minor for the purpose of tranplantation

 The human body and its parts cannot be the subject of commerial transactions. Accordingly, giving or
receiving payments (including any compensation or reward for organs should be prohibited

o Results from a rapidly increasing demand due to high succes rate of organ transplantaion
o Creating an ever-widenning gap between organ demand and organ supply

DEMAND
ORGAN
SELLING

- Ethical or unethical
SUPPLY

Principle of Ordinary and extra ordinary means

• Ordinary means

"ordinary means of preserving life are all medicine, treaments and operations which offer a reasonable hope of
benefit for the patient and which can be obtained and used without excessive expense, pain or other inconve nience."

• Extraordinary means

"Extraordinary means of preserving life are those treatments, medicines and operations which are gravely
burdensome to the patient, and which cannot be obtained or used without excessive expense, pain or other
inconvenience or which ,if used, would not offer a reasonable hope of benefit to the patient"

Distinguishing Ordinary and Extraordinary Means

In general, such decisions:

o must always be case specific;

o must be re-evaluated regularly as the situation evolves;
o Require prudential application of principles to achieve whatever "moral certitude" is possible
o Are best made with broad consultation among patient, family members, medical team, and perhaps ethics
committe/consultants
o Are medical decisions, to be based on medical indications, in light of the holistic view of the person who is in
a particular situation

Principle of Personalized Sexuality

o The gift of sexuality must be used in keeping with the intrinsic human teleology

o Personalized sexuality is based on an understanding of sexuality as one of the basic traits of a person and
must be developed in ways consistent with enhancing human dignity

o Sexuality is a complex aspect of our personality and 'self'. Our sexuality is defined by sexual thoughts,
desires and longings, erotic fantasies, turn-ons andexperience