BIOETHICS

Arke Engel Marx D.V. Nicolas, J.D.,

RMT
Introduction to Bioethics

• This chapter intends to explain the

impacts and complexities of bioethics in
the practice of medical technology in
the Philippines. Although this country
follows written laws, established
bioethical standards are being adopted
as part of equity jurisdiction only when
there is a gap or obscurity in
interpreting and applying health
statutes.
 WHAT IS BIOETHICS

• In the Philippines, bioethics is defined

as a philosophical discipline that deals
with the study of the morality of human
conduct in relation to health in
particular and to human life in general.
 What is the objective of
this chapter?
• Clearly, the core of bioethics is to assist
healthcare providers in reaching sound
decisions before introducing any medical
intervention to, any, person at any stage Of
his/her life. In pursuing this objective, factors
like philosophy, theology, law, and life sciences
are essentially important. The principles and
concepts of these factors serve as grounds in
arriving at choices for patient care To this,
therefore, the soul of every sound decision is
a just reason
• Aside from its essential role in addressing
health issues, bioethics is vital in bridging the
gaps in health legislation.
• Due to the tremendous development in life
sciences, several health science issues
emerged, i.e., preservation and termination of
life, reproductive rights, mutilation and organ
replacement,. biomedical research, and so on.
These bioethical concerns usually result in
societal tension.
What is the answer of our
legislators on this matter?
• In response to these. matters, with due
observance of human rights and integrity, health
legislations have been passed to regulate health
science practices and to prevent abuse in its
utilization, such as Organ Donation Act,
Responsible Parenthood and Reproductive
Health Act" ,Clinical Laboratory Law, and
Philippine Medical Technology Act. Health
legislations containing concepts and principles of
bioethics are the response of an organized society
when confronted by a certain bioethical issue.
 What is Ethics?

• Ethics is defined as a branch of

philosophy that deals with the morality
of human conduct. It is also defined as
the formal study of moral choices that
conforms to standards of conduct.
 What is Morality?

• Morality is the quality of a human

conduct.

• *Obviously, ethics by its nature becomes

a tool used to determine whether the
answer or behavior is grounded for a
reason and whether such reason fulfills
what is important to a person or in
accordance with one's duty.
 Ethical theories

• There are three categories of ethical

theories, these are:
• (1) normative ethics,
• (2) meta-ethics,
• and (3) applied ethics.
 Normative ethics

• It seeks to set norms or standards for

conduct. The term is. commonly used in
reference to the decision of general theories
about what one ought to do.
• Application : how a medical technologist should
behave, what ought to be done in certain
situations, what type of character one should
behave, or how it should be done in dealing with
patients and the public, colleagues in the
profession, physicians, and toward the hospital
as a whole.
 Meta-ethics

• Also known as analytical ethics, does not deal

with the substantive content of ethical theories
or moral judgments but rather with questions
about their nature, such as question whether
moral judgments are objective or subjective.
• Application: What is an ideal medical
technologist? Is an ideal medical technologist a
perfect medical technologist? Is the transfusion
of unscreened blood unit ethically wrong or
refusal of transfusion based on religious belief is
ethically right?
 Applied ethics

• Or practical ethics, is the application of

normative ethical theories to practical
problems. It is a definite application of
ethics to a specific bioethical issue.
• Examples of applied ethics are
bioethics, medical ethics, professional
ethics, and health ethics.
 Human Act
• An act is said to be a human act when performed
by a person with full knowledge or intelligence
and on his/her own volition and free will thus, the
following are factors that affect human acts:
• (1) knowledge,
• (2)freedom and
• (3) Voluntariness
• The absence of any of the three factors will not
qualify an act as a human act but rather, an act of
a human.
 Examples of act as a
human and human act
• 1 A medical technologist who acted under
threat, duress, coercion, or compulsion.
• 2. The acts of a medical technologist who
lost his/her sanity during the course of
employment.
• 3. Benevolence and charitable acts of a
medical technologist to needy and
indigent patients.
 What is Bioethics?

• is a philosophical discipline that deals

with the study of the morality of human
conduct in relation to health in
particular and to human life in general
 Major Bioethical
Principles
• 1. principle of respect for autonomy
• 2. principle of beneficence
• 3. principle of non-maleficence
• 4. principle of justice
Principle of respect for autonomy

• It means that health care professionals

should respect the autonomous
decisions of competent adults.
• It is the ability of a person to give
consent after due information of medical
intervention.
• HOWEVER, If it is a minor, it will be
exercised by the parents/guardians/ or
representative/s of the minor.
Examples of health legislation that
mandate the requirement of
informed consent are:

• Philippine HIV and AIDS Policy Act before

conducting an HIV test,
• Comprehensive Dangerous Drugs Act
before conducting a drug test, and
• Newborn Screening Act before conducting
a newborn screening test
• Scenarios that are critical to apply the
principle: abortion, suicide and
euthanasia
 Principle of beneficence

• Health care provider should aim to do

good.
• It should be beneficial to the patient. In
medical technology standpoint, it shall
be used to promote life and benefit of
humanity.
• ** in case that there is a conflict
between the 2 principles(autonomy vs
beneficence), the former will prevail.
• Example: newborn screening. While the
test is beneficial for the newborn, the
parents, in the exercise of autonomous
decision, may refuse to subject their
newborn to such a test.
 Principle of Non-
maleficence
• Health care provider should do no harm.
• *harm or injury maybe committed
maliciously(dolo) or by means of fault(culpa).
• **fault or culpa= negligence and imprudence
• **dolo or malicious= intention to do harm
• scenarios: deliberate used of syringe to a
patient is malicious harm.
Manifestation of hematoma is a result of poor
phlebotomy technique is negligent harm.
 Principle of justice

• Health care professionals should act fairly

when the interests of different individuals
or groups in competition.
• 2 types
• *comparative justice- balancing the
competing interests of individual and
groups against one another.
• *distributive justice- fair distribution of
health care services to all.
 In clinical laboratory
perspective
• Giving priority to emergency cases,
persons with disabilities, pregnant
women, and senior citizens.-
comparative justice
• Higher interest in health care services and
special medical attention.

• First come, first serve policy –

distributive justice
 Professional Ethics

• It is concerned with the standards and

moral conduct that govern a profession
and its members.
• **the revised code of ethics for medical
technology was enacted on march
7,1997.
• **it serves as the basis of the
professional ethics of the profession.
 Accept the responsibilities
inherent to being a professional

• A medical technologist must conduct

himself/herself as a professional at all times
by resonating both his/her legal and moral
responsibilities enumerated in the Revised Code of
Ethics, Professional Oath, R.A. No. 5527, and
other related laws. These are all in sacred trust
which a medical technologist is bound to follow.
• It is also expected for a medical technologist
to deliver quality health care. The duty of care
required from a medical technologist must remain
inviolable.
 Illustration:

• 1. A medical technologist should observe

honesty; candor, decency, proper decorum, and
charity in dealing with patients.
• 2. The medical technologist should not inflict
any injury to his/her patients.
• 3. The medical technologist should work with a
valid PRC license and renew it upon expiration.
• 4. A medical technologist should always work
under the supervision of a pathologist.
Uphold the law and shall not
participate in illegal work
• A medical technologist must obey and respect
existing and prevailing laws. This being the case,
a medical technologist must also be mindful of these
controlling statutes. A breach of these laws amounts
to a violation.
• It is also the responsibility of a medical
technologist to avoid participating in illegal
activities. A medical technologist may be exposed to
the following: falsifying laboratory results, working
with an expired, suspended, or revoked license, and
working without the supervision of a pathologist.
 Illustration
• 1. It is the responsibility of a medical technologist to comply with
the requirements of RA. No. 5527 before entering into the practice
of medical technology.
• 2. It is the responsibility of the medical technologist to secure
consent as required by the R.A. No. 9165. or R.A No. 11166 before
subjecting the patient to a drug test or HIV test, as the case may be.
• 3. It is the duty of the medical technologist to comply with the CPD
law and earn CPD units before renewing a professional license.
• 4. A medical, technologist has no obligation to issue a falsified
laboratory result
• 5. It . is unlawful for a medical technologist to extort money Or
demand sexual favors in exchange for a favorable laboratory result.
Act in the spirit of fairness to all and
in a spirit of brotherhood toward
other members of the profession

• A medical technologist must show

impartiality, courtesy, and respect
toward other members of the
profession. He/She should not resort to
harassment and discrimination in
dealing with colleagues. His/Her
language should, not provoke or suggest
contempt but instead should promote
solidarity in the practice.
 Illustration

• 1. A medical technologist shall be polite,

composed, and courteous in his/her
dealings with other medical
technologists.
• 2. A medical technologist, shall refrain
from showing bias and prejudice to
other members of the profession on the
basis of gender, age, and social status.
Accept employment from more than
one employer only when there is no
conflict of interest

• A medical technologist must also

show to his/her employment. He/She
can accept other jobs ,subject to the
condition that there is no "conflict
of interest." The proscription of
"conflict of interest" dwells on the basic
obligation of a medical technologist to
show undivided loyalty to his/ her
primary employment.
 Illustration

• 1. A medical technologist shall not

accept a second position with another
employer when the second job requires
disclosure of trade secrets of the first
employment.
• 2. A medical technologist shall not
accept additional employment offers
whose work hours overlap with the first
post.
Perform my task with full confidence,
absolute reliability, and accuracy

• One of the laudable thrusts of the profession is

to aid the physician in the diagnosis and
treatment of diseases and to promote health in
general. This mandate can only be achieved when a
medical technologist carries his/her task with full
confidence, absolute reliability, and accuracy.
• This is necessary because the profession deals with
human lives which must be protected from the time of
conception until death. Any action of the medical
technologist that diverts from the standards of
practice will entail risk or threaten the well-being of
the patient.
 Illustration
• 1 A medical technologist should observe the
required standard of practice in processing a
laboratory specimen.
• 2. A medical technologist should reject unlabeled
specimens and shall require repeat collection. -
• 3. A medical technologist should not issue
unscreened blood units for transfusion.
• 4.A medical technologist should not issue a
laboratory result that is not verified and
approved by a pathologist.
Share my knowledge and expertise
with my colleagues, and contribute
to the advancement of the
professional organization and-other
allied health organization
• This ethical dictum adheres to the concept of
stewardship. Medical technologists are
enjoined not only to aid the physician in the
diagnosis and treatment of disease but also
to help develop this craft.
• As a steward, a medical technologist
should participate in advancing the
profession by conducting biomedical
research and innovating existing
medical technologies
 Illustration

• 1. A medical technologist shall endeavor

develop alternative culture media and cost-
effective reagents.
• 2 A medical technologist shall participate
in discovering the causative agents of
novel diseases and their cure, if possible.
• 3 A medical technologist shall participate
in improving the magnification and
resolution .of microscopes.
Restrict my praises, criticisms, views,
and opinions within constructive limits

• A medical technologist must be

polite and respectful in his/her
language at all times. He/She shall
thus refrain from using abusive and
intemperate dialectal words, especially
in expressing his/her criticisms, views,
and opinions so as not to foster inimical
and hostile employment.
 Illustration
• A medical technologist who uses abusive, defamatory, and
slanderous words in describing the work ethics of his/her
colleagues like: "Putang inang bobong med tech. na yan!", "Mag
prick na nga lang, sablay sablay pa!", "Manufacturer ng pekeng
lab results yan!",. "Kabit yan ni Doc", and 'Ang tamad ng med
tech. na yan, hindi lang cotton balls lang kayang bilugin,.pati si
Doc na bilog na niya!" is guilty in violating this ethical mandate.
• A senior medical technologist who slaps his/her underperforming
junior colleague due to uncontrollable disappointment and work
dissatisfaction is also liable under this ethical dictum.
• A senior medical technologist who humiliates his/her junior
medical technologist in front of the patient. is equally liable for
violating this ethical standard.
 Treat any information I acquired in the
course of my work as strictly confidential

• This ethical aphorism provides for the

Confidentiality Rule. This rule establishes its
foundation from the basic ;right of a person to
privacy. Numerous health legislations, including,
but not limited to, R A No 5527, R.A. No. 11166,
and R.A. No: 9165, reflect this rule as an important
facet of a person’s basic right to privacy. Another
development that affects this ethical standards the
passage of the Data Privacy 'Act of 2012 where
sensitive personal information, including health
information, is protected and treated as
confidential.
 Illustration

• 1. A medical technologist who discloses the

HIV test results of a patient to another
person not involved in the direct care of the
former violates the policy of medical
confidentiality.
• 2. A medical technologist who issues the
laboratory result to a third person other
than the patient, requesting physician, or
authorized representative of the patient
violates this code.
Uphold the dignity, and respect
of my profession and conduct
myself a reputation of
reliability, honesty, and
integrity must
• A medical technologist
preserve the integrity of the
profession by abiding with the laws
in general, observe established
scientific standards and procedures, and
uphold the ethical norms of the practice.
He/She should avoid delaying the
delivery of quality health-care services
due to corrupt practices, ill motives,
malice, or money.
 Illustration
• 1 A medical technologist who advocates selling blood units or
body organs violates this code
• 2 A medical technologist who prioritizes his/her personal
interest over those of his/her, patients or a medical
technologist who exposes his/her patients to unnecessary
harm also infringes on this concept.
• 3. A medical technologist who sexually assaults or makes
erotic contacts with his/her patients gravely violates this
code.
• 4. A medical technologist who propagates wrong and
misleading scientific information also violates this code.
• 5 A medical technologist who interprets laboratory results to
patients and prescribes drugs violates this code.
 Be dedicated to the use of clinical
laboratory science to promote life
and benefit mankind

• A medical technologist must use

his/her knowledge to benefit
humanity. It is the sacred mission of a
medical technologist to use his/her
vocation to promote life and not
otherwise. He/She must not exploit his/
her knowledge in science and thereby
bring harm and injury to his/her
patients and colleagues.
 Illustration

• 1 A medical technologist who uses his/her

knowledge to develop biological weapons for
warfare infringes on this code
• 2 A medical technologist who utilizes
laboratory tests to pry on the privacy of
patients violates this code.
• 3. A medical technologist who actively
participates in abortion and assists a person
to commit suicide also runs contrary to the
wisdom of this code.
 Report any violation of the above principles of
the professional conduct to the authorized
agency and the ethics committee of the
organization

• This ethical standard requires a medical

technologist to report ethical violations to the
authorized agency or authorized professional
organization. At present, the PRC, on its own or
through the Medical Technology Board, are the
governing bodies that are allowed to resolve
complaints about violating this Code For erring
medical technologists employed in the government,
complaints may be lodged with the Civil Service
Commission or to the Office of the Ombudsman, if
necessary. PAMET may also take remedial actions
on its erring members.
 Illustration
• 1. A medical technologist who fails to report acts of
medical malpractice amounts to actionable conduct
of omission
• 2 A medical technologist who is fully aware that a
clinical laboratory lacks a valid license to operate
but fails to report it is also guilty of omission.
• 3 A medical technologist employed by the
government who is fully aware that the bidding
process for acquisition of reagents and clinical
laboratory supplies was rigged and fails to report it
is also guilty of violating this code.
 Liabilities of a medical
technologist
• 1. negligence vs. Imprudence
• 2. Res Ipsa Loquitur
• 3. Criminal liabilities
 Negligence vs
Imprudence
• Negligence is deficiency of
perception or lack of foresight: the
failure to foresee impending injury,
thoughtlessness, failure to use
ordinary care. Whereas, imprudence
is deficiency of action in avoiding an
injury due to lack of skill. Both
result to a culpable felony.
 Res Ipsa Loquitur

• This doctrine arose where the thing

which causes injury is shown to be
under the management of the offender,
and the accident is such as in the
ordinary course of things does not
happen if those who have the
management use proper care, it affords
reasonable evidence, in the absence of
an explanation by the offender, that the
accident arose from the want of care.
 Criminal liabilities

• If he/ she commits or omits an act

treated by the law as a crime.
• * if a crime is punishable by the revised
penal code-felony.
• *if the crime is punishable by other
special penal laws- offense.
 Bioethical Issues

• 1. destruction of life
• Abortion
• Euthanasia and Assisted suicide
• 2. Sustaining life
• Withholding life support
• Organ transplantation