INTRODUCTION: BASIC ETHICAL CONCEPTS

Geraldine S. Canete, MAN, RN

Ethics according to Aristotle comes from the Greek word “ethos” or “ethous” meaning use, custom, way of behaving,
character and corresponds to the Latin term “mos” or “moris”. These behaviours are basic human behaviors that are
part of human nature ← specific & inherent to human beings. They are natural to human which confers and develops goodness in them.

Ethics as you have learned, is that branch of Philosophy that deals with the principles of morality and the well-defined
standards of right and wrong that prescribe the human character and conduct, in terms of obligations, rights, rules,
benefit to society, fairness etc. In simple terms, Ethics is that field of philosophy that specifically studies human acts
in the light of morality. The issue of man’s action in every stage of life will always be a source of enduring philosophical
wonder.
rational
inquiry into what constitute human
happiness in the light of human nature as
reflected in human conduct
empirically
and
emphatically observed
and
-

study of the end of man

of human acts
insofar as
they are related to that end → based on the life after death 1 reincarnation 1 remembrance

WHAT ARE HUMAN ACTS?

Human acts being the object of study of Ethics are voluntary acts which proceeds from the free will. Human acts
depend on human’s judgment and choice hence entail a moral responsibility. Human acts form the human
personality and structure. Human acts that humans perform, build up their lives. The doing or the absence of doing
build the kind of life the person lives. (Ocampo, 2018) The kind of life that is good, well and happy. For patients, the
kind of life that is healthy.

St. Thomas Aquinas asserted that, in the study of moral philosophy or ethics, human acts are said to be proceeding
from man’s will according to the dictate of reason. Acts performed by the individual which are not subject to his will
and reason are not called strictly human acts but rather are natural acts. (Ortigas,
2006, p. 66)

Below is the bullet point summary about the difference between human acts and natural acts of man.

Keypoints:

• All Human act are subjected to morality.

• Human acts are different from animal act because man by nature acts towards an end. His life has a
purpose.
• Human acts are those that are freely chosen in consequence of a judgment of conscience.
• They are either good or evil.
• Their morality depends on: the object chosen, the intention and the circumstances.
• Human Acts are not merely physical events that come & go, like the falling of rain or the turning of the
leaves, nor do they as Karol Wojtyla emphasized in THE ACTING PERSON, “happen” to a person.
• They are, rather, the outward expression if a person’s choices for at the core of a human act is free, self
determining choice, an act of the will, which as such is something spiritual that abides within the
person, giving him his identity as a moral being.
 • Although many human acts have physical, observable components, they are morally significant because
they embody and carry out free human choices.
• We are free to choose what we are to do and, by so choosing, to make ourselves the kind of person
we are.
• But we are not free to make what we choose to do to be good or evil, right or wrong.
• We know this from our own sad experience, for at time we have freely chosen to do things that we
knew, at the very moment we choose to do them, were morally wrong. We can, in short, choose badly
or well.

Human acts
Actions done Consciously and freely by the agent/or by man
ESSENTIAL QUALITIES/ Constituent Elements of Human Acts
1. Knowledge of the act
2. Freedom
3. Voluntariness
Man takes into responsibility of these actions

Natural Acts of Man

Actions beyond one’s consciousness; not dependent on the intellect & the will.
• ESSENTIAL QUALITIES of Acts of Man
– Done without knowledge
– Without consent
– Involuntary
• Ex: unconscious, involuntary, semi-deliberate, spontaneous actions
• Acts of man can become human acts when he employs his intellect & will in performing the act.

ACTS not morally accountable

• Acts of persons asleep or under hypnosis.
• Reflex actions where the will has no time to intervene.
• Acts of performed under serious physical violence
• e.g. a hostage obliged to do an evil action.
• Since the will is constrained, then it is not a moral act which could be evaluated.
Discussion activity:
Identify which of the following is a human act (HA) or a natural act of man (NAM).
/1. Looking HA
2.
/ Seeing NAM

3.
/
Dreaming NAM
4.
/ Day dreaming HA

5. Hearing NAM
/

6. Listening HA
/

/Walking HA
7.
/
8. Sleepwalking NAM

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Why do we need to study human acts?

I have my answer from Socrates famous and inspiring thesis which says “the unexamined life is not worth living”.
And this Socratic Method is realized in conversation- in dialogue.

Imagine Socrates in the olden days, receiving inquiries from pre-socratic philosophers and there in the marketplace,
the Agora, started discussions with different people from different walks of life earnestly exchanging ideas
with one another. The fundamental attitude of the Greeks towards knowledge is truly inspiring and worth
emulating. For them true knowledge has been forged with criticism and judicious reflections, tested and tried.

It is my hope that as we study human acts in different bioethical issues, we will also earnestly share ideas even though
we are not seeing each other in the classroom with everyone willing to go deeper, wider and higher in terms of
studying human acts to develop sound ethical judgment in every ethical issue we encounter as nurses.

ON ETHICAL DILEMMA

To be able to assist patients/clients ethically -be it individuals, families, population groups and/or community-
nurses are to develop sound ethical judgment along with scientific knowledge and interpersonal skills.

Nurses are guided by the broad base of knowledge sifted through the critical and creative skills to determine
what is good and bad for the patients. However, there are times when we face a dilemma whenever we
encounter two opposing yet equally beneficial for the patients.

Example of Ethical Dilemma Nurses encounter:

1. A young woman asking for abortion because she is not ready for a baby and has no job. – you believe in the
inviolability of life yet you also understand the young woman’s predicament on raising the child and
respects her autonomy.
2. A woman with congestive heart disease pregnant, being asked to terminate pregnancy but wants to deliver
the baby to full term despite the risk on her part. – you respect the patient’s autonomy and also believes in
the inviolability of life yet you also recognize the risk and harm the patient is facing due to her pregnancy,
3. A cancer patient in pain asking for more morphine despite being given already the prescribed dosage. – you
understand the suffering of the patient but you also recognize that harm that morphine can do and
can’t do on terminal pain.
4. An old couple wanting for a designer baby – you believe in the natural law yet you also recognize the longing
of the old couple to have a child of their own liking.
5. A middle age couple, childless, wanting for surrogate mother to carry their child. – you believe in the natural
law yet you also understand the longings of the middle age couple to have a child.
6. A young man selling his kidney so he can support his ailing child. – you believe in the principle of totality yet
you also understand the young man’s needs to support his family.

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 7. A young man choosing sex reassignment surgery because he doesn’t want to live any longer as a man. – you
believe in the natural law yet you also believe in respecting the autonomy/freedom of choice of the young
man.
8. You want to pass the summative exam to maintain your scholarship, but you did not study, then
here comes your classmate offering help by sharing her answers. – you believe in the principle of veracity
that supports truth regarding your capacity yet you also do not want to fail the summative exam and lose
the scholarship.

The list can go on as the person progresses in his or her personal and professional life. Oftentimes though, a person
is left wondering with a dilemma: How to decide in the face of what appears to be two equally good and beneficial
options.

Questions worth asking ourselves are, how do we know if it is good? how do we know if it is bad? In the face of what
seems to be two equally good, how do we choose which is the better good. Where does goodness come from?

To determine the good requires careful study and reflection. Humans are equipped to search for what is good in the
world and what is good in human action. It is the main focus of Aristotle in his writings on Ethics as what you have
learned in your Philosophy subject. The Ethics of Aristotle investigates the goodness of human acts that build a
good life.

Human acts take on the ethical feature when it is examined based on its value as good or bad. Hence, it is important
that we know how to determine the goodness and badness of human actions.

ON WHAT IS GOOD
In the previous years that I was teaching Bioethics first, for Dentistry students and now Student Nurses, a few
students wrote in their reflective paper about their musings on what is good. Oftentimes I wished I have offered a
more in-depth discussion. I initially did not include this topic in the early years, since I believed this can be
covered on other subjects like Philosophy and Anthropology. However, I decided to insert a brief discussion because
I do not want to regret not discussing whenever I read the reflective papers of my students.

On the question “what is good”, Dr. Ma. Liza Ocampo, the author of Ethics Primer, wrote an exhaustive chapter on
the Moral Good. She wrote that Aristotle critiqued Plato’s form of Good. According to her If Plato believed that there
is a single form of good and virtue, Aristotle argued that there exists, multiple virtues of varying degrees. These
virtues can be acquired through the practice of habit. (Ocampo, 2018, p. 56) Furthermore, Aristotle asserted in his
Nicomachean Ethics (after the name of his son Nicomachus), that goodness in the moral world for him, allows for
degrees, levels and difference.

Keypoints on Moral Good

The following is a point by point summary I wrote based from Dr. Ocampo’s discussion of Aristotle’s writing on Moral
Good:

1. The sense of good or the good of man can be understood not only on how the said good affects himself but
also with those around him since man is a political animal.

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 2. Aside from existing in degrees, levels and differences, the senses of good can be understood in an empirical
manner. The good (of human experience) has to be seen, heard, touched, tasted and felt.
3. All forms of good actions seek happiness. eudaimonia-7

4. To understand moral goodness, study the soul of man. (From chapter 13 of Nicomachean Ethics)
– one does not grow in the true understanding if the soul is unknown. Aristotle wrote: “But by human
goodness is meant goodness not of the body but of the soul and happiness we define as an activity of the
soul. This being so, it is understood that a doctor who intends to treat the eye must have a knowledge of
the body as a whole, and a statesman too must study with the view of politics”
5. The content of moral goodness passes through reason and will and the mark of moral goodness passes
through the teat of rationality through different people, places and cultures.
6. Moral goodness has to be contextualized in different times and places hence there is a need to study different
cultures, histories and cases to understand the core of the moral goodness at that particular time and space.
7. Moral goodness is described in terms of: honorable good, useful good and pleasurable good.
The language and classification of these goods is based on the natural movements of man’s dynamic
appetite. (this can be studied further on human anthropology)

Honorable good – is a good which is desired in itself because of its intrinsic goodness, which means
that man naturally tends towards these goods. Example: any virtue, health, science and wellness.

Pleasurable good – is the same honorable good in as much as its possession silences desire and produces
joy. Examples are any sense-perceptible good in so far as it produces pleasure or delight and the satisfaction
produced by a virtue of by scientific knowledge.

Useful good – is a good which is not desired for its own goodness but for the sake of attaining some other
good. It is a good which is desired as a means. It is not desired for its own sake but for the sake of honorable
or pleasurable good. Any useful good is directed towards an ultimate good. Example: bitter medicine to
obtain health or a painful surgery to help a person recover from a diseased organ and be healthy.
8. The honorable, pleasurable and useful goods are analogous and relate to each other in varying situations.
The character of being good primarily befits the honorable good, secondarily the pleasurable good
and remotely, the useful good.
9. The honorable and the pleasurable good are linked together since the source of joy is the good and the root
of pain is evil. The good is delightful and causes greater satisfaction while privation of good/evil or bad
results to sadness and pain.
honorable good amidst ←
10. Sometimes the honorable good is dissociated from the pleasurable good. Badness or evil ca be pleasing
pain and suffering
because of some good that accompanies it but not necessarily honorable. The delight produced by this is
transitory and deceptive and oftentimes in the end is transformed into pain. Example, a prohibited drugs
that can give some pleasure. Similarly, an honorable good may be painful. Example, healing process often
involves painful cures like surgery or breaking away from a disordered relationship or breaking off from an
unhealthy habit (too much eating, no exercise, drinking, etc.).

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 11. Goodness is objective and is not a matter of man’s subjective take on the goodness of the things in the
world. The default mode of the rational appetite of man is to go after the good. Example, how does a baby
learn that breastmilk is its food? No one taught the baby to consume milk. Yes the mother offered her breast
but the baby consumed the breastmilk.
12. Moral good especially the higher moral good, the honorable good are acquired through the
exercise of virtue and reason.
13. Any existent thing or living being is not good because it is desirable. It is desirable because it is good.

NORMS OF HUMAN ACTS

• These are directives or guides in making decisions on what we ought to do or to be.

a. Law – an ordinance of reason, promulgated for the common good by one who has legitimate authority. It
is an authoritative order that should be just, honest, possible of fulfilment, useful, to a certain degree of
permanency and promulgated or made known to the subject.
b. Conscience – the practical judgment of reason upon an individual act as good and to be
performed or as evil and to be avoided.

IMPORTANT CLASSES OF LAWS

a. Eternal Law – It is God’s eternal plan and providence for the universe. It is the diverse reason or will
commanding the preservation of the natural order of things and forbidding its disturbance. According to
St. Thomas, it is the plan flowing from God’s wisdom directing all acts and movements.

b. Natural Law – it is the eternal law as known to human through reason. It is nothing than the rational
creatures’ participation in the eternal law of God and Human comes to the knowledge of this law by natural
light of his/her reason. e.g. do good and avoid evil. (St. Thomas)

• The reason why it is called Natural is because it is neither communicated in a supernatural way, nor a
result of a command of a legislative or authority. The precept of natural law is found and derived for the
very nature of human beings.

PROPERTIES OF NATURAL LAW

a. Universality – the natural moral law binds every person at all times and in all places or its basis is the very
nature of human. One cannot remain ignorant of the natural law, at least not of its basic precepts. However,
human beings do not possess the knowledge of this law, in a fully
developed form from the beginning. She or he must develop it just as the development of other forms of
knowledge. E.g. respect for life
b. Immutability – as soon as the human being has the capacity of using his/her reason, certain fundamental
norms will become self-evident to humans. These fundamental norms are imprinted in human nature, so
that they exist as long as human nature exists. The genuine commands and prohibitions of natural law
cannot be changed.

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 c. Indispensability – no one is dispended or excused in the observance of the natural law. Why?
Because, the origin of natural law is God. Natural law is identical to God’s will. Evidently, human has no
authority over a law of this status. This means that if there is dispensation of this law, there is a violation
in God’s Law.

TYPES OF NATURAL LAW AS PRESENTED OR FORBID AN ACT

1. Affirmative – laws which bind always, but not at very moment. It states that human is morally obliged
to adopt all ordinary means of preserving health and life. However, not morally obliged to adopt
extraordinary means of preserving life, except if the point is not spiritually prepared for death. Humans
may adopt extraordinary means to conserve health and life. If it appears to be useful, desirable and
prudent thing to do.
2. Negative – laws that are prohibitory. These are laws of the natural order, which bind always and at
every moment. It states that no act – (+) or (-). Maybe directly, deliberately willed as a means of
destroying health or life.

At this point, it is good that we identify the ordinary from extraordinary means of preserving life, from the
standpoints of physicians and moralists.

VIEWPOINTS ORDINARY MEANS EXTRAORDINARY MEANS

PHYSICIANS Standard, recognized, established A medicine or procedure that might
medicines or procedure of the be fanciful, bizarre, experimental,
period at the level of medical incompletely establishes and not
practice. recognized.
MORALISTS Include not only normal food, drink All medicines, treatments and
and rest but also in terms of operations which cannot be
hospital practice, all medicines obtained or used of excessive
and treatment procedures which expense, pain or other
offer reasonable hope or benefit inconvenience for the point or
for the patient which can be for others, or which if used would
obtained and used of excessive offer a reasonable hope for the
expense, pain or other point.
inconvenience.

3. HUMAN POSITIVE LAW

• Law enhanced by the church or state.
• An ordinance of reason derived from the natural law or making a concrete and determinate
application of the natural law, promulgated for the common good by a human institution in charge
of society.

Note: Whenever we perform actions that are in conformity to the law, it is good. We are talking now of laws that
are also morally sound, this will guide us not only to become citizens who abide to certain rules but also develop us
to become moral individuals. The knowledge on the different aspects of laws will enable us to become more
careful in following the norms to fulfill our duty in the preservation of human life.

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 In studying human activity in the strictest sense, one has to recognize that such activity stems from freedom and is
directed towards a final goal. (Alvira & Rodriguez, 1992 cited in Ocampo, 2018, p. 8). Hence, for acts to be called
human acts, they must be voluntary not coerced, done with full knowledge and based on an intention towards
achieving a certain end. And Good is the basic reality of the moral order and the end of man because again, the
default mode of the rational appetite is is to go after the good.

Ethics is then considered an important practical science since it studies how human acts are directed towards
man’s purpose or end. It does not stop at the contemplation of truths but applies that learning into actions, providing
the necessary knowledge so man can choose what is good and consequently live in a morally upright way. (Ortigas,
2006)

REFERENCES:

Edge, R. & Groves, J. (2019) Ethics of Health Care: A Guide for Clinical Practice. 4th ed. Philippine Edition: Cengage
Learning Asia Pte. Ltd.,.

Monge, M. (2014) Ethics in Medical Practice: Summary, Explanation & Defense of Concrete Ethical
Problems. Revised Edition. Manila: Sinagtala Publishers

Ocampo, M. L. R. (2018) Ethics Primer A Young Person’s Guide to Moral Reasoning. Vibal Group, Inc. Rice, C.

(1996) 50 Questions on the Natural Law: What It Is & Why We Need It. Ignatius Press,

Scgreccia, E. (2012) Personalist Bioethics: Foundations and Applications (T. Di Camillo, J. & Miller, M.
Translation). The National Catholic Bioethics Center. 2007, 1998, 1994, 1988

Internet sources
1. https://opusdei.org/en/article/topic-26-freedom-law-and-conscience/
2. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_200812
08_dignitas-personae_en.html Dignitas Personae Document September 8, 2008

BSN 209

I think the first two readings kindled curiosity in me to know more about ethics and its application in the delivery of health care. This course
will help me become objective in making decisions regarding the welfare of my patients.

I feel intrigued and curious on how to solve the stated ethical dilemmas encountered by the nurses. I am excited to learn the ethical principles
that will be the basis in handling such situations.

I learned the importance of Ethics in living a moral life and to treat others fairly and well. Also, freedom comes with responsibility and we
must always examine ourselves and listen to our conscience.

I suggest to explore other ethical views aside from the Natural Law because there are people who have different views from the Catholic
Church.

I plan to read the next modules and look for other resources to expand my knowledge about this topic. I would also reflect on what I learned
and see what I can apply to my life and become more ethical.
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 ETHICAL THEORIES
Geraldine S. Canete, MAN, RN

A human person act based on reason and will. With will, he chooses to do something that is determined by his reason
that is ought to be done. With reason, he makes use of his mind and embark on seeking for knowledge. For nurses,
we study the broad base of knowledge and use this knowledge as basis of our nursing actions. We try to aim for
objective facts, tested and tried to be sound and effective to ensure correctness and safety of our nursing care plan.
We justify and rationalize our judgments, decisions and actions based on this objective notion of what is good. By
objective, we mean it is not based on feelings or personal motivations and instead a product of careful reflections
and rigorous scientific evidence-based study.

In ethics, there are ethical theories that guide us also in ethical decision-making. However, some of these theories
oppose one another i.e. ethical egoism and virtue ethics etc, leaving the person unable to decide on which theory he
can make use as anchor of any ethical decisions.

As a teacher in ethics for several years and upon observing of the world and reality around me, I have come to the
conclusion that some people choose a framework based on what suits his or her needs. Which in itself it truly
subjective.

However, Ethics must be objective, otherwise it fails to set a standard that will guide human character. Nevertheless,
for purposes of scholarly study, we discuss the different ethical theories to have a wider perspective of the
several ethical theories. A separate discussion will be dedicated to attempt a discussion on how to do ethical decision-
making and how to determine the goodness and badness of a human act in simple terms.

Summary of Ethical Theories

1. Teleological Ethical Theories – rightness and wrongness solely depend on the consequence
duty nationality and
,
,
←
2. Deontological Ethical Theories – actions are morally right independent of their consequences
obedience to duty
3. Virtue Ethical Theories – ethical value is determined by his character which refers to virtues,
inclinations and intentions that dispose of a person to be ready to act ethically. Character builds a
substantive moral foundation for one’s actions. A person with the strong character has imbibed emotional,
intellectual, moral and social virtues to achieve the self-discipline to do what is right and good. Whereas a
person with weak character finds himself doing the wrong things and doing what is harmful to him and
makes excuses for all his actions.
4. System Development Ethical Theories – the extent to which organization system is sensitive to the need
to develop a work culture supportive of ethical conduct determine the ethical values of actions. If
the organization do not implement morally supportive systems then the organization is exposed to future
ethical risks.

An ethical theory provides a framework within which agents can reflect on the acceptability of actions and can evaluate
moral judgments and moral character
 Types of Teleological Ethical Theories:
for benefit own 1. Ethical Egoism – It posits that an action is good is it produces or is likely to produce results that maximize
d-

the person’s self-interest which the person himself defines. Even at the expense of others. It is based
on the notion that it is always right to promote one’s own good. Lockdown benefits the many to prevent spread but
- a -

,
the
poor can 't work

for the
benefit of many
the 2. Utilitarianism – posits that an action is good if it results in maximum satisfaction for a large number
←

ex population control
.

of people who are likely to get affected by the action.

happiness and of 3. Eudaimonism – It posits that an action is good if it results in the fulfillment of goals along with the welfare
sense
←

fulfillment
ext . to t classes
of HA students
of the human beings. The actions are said to be fruitful if it promotes or tends to promote the fulfillment of
goals that constitute human nature and its happiness.

Types of Deontological Ethical theories: →

according to the ruler

protection from harm 1. Negative a-

and Positive Rights Theories – asserts that an action is right if it protects the individual from harm
and interference

academic freedom freedom of speech

or unwarranted interference from other people or the government while exercising his right. The Example:
selling your property without the interference of others. The positive right theory posits that an action
,

Issue
ridtagging
:

is right if it provides an individual with anything that he needs to exist. Example, right to adequate health
care.
agreement to met harm others 2. Social Contract Theories – posits that people contract with each other to abide by the moral and political
←

so wouldn't he harm too

you
obligations towards the society in which they live. This theory is based on the notion that if there is no order
,

and law in the society, then people will have unlimited freedoms like killing another because of too much
hatred, stealing money and property because one needs it etc. What chaotic world it would be, thus, people
enter into an agreement with each other to give up some of their freedoms and accept the obligation to
respect and safeguard the rights of others. The individual then gains a civil rights that constitute the social
benefits that he is entitled to the extent he fulfills his due obligations towards society.
3. Social Justice Theories – it asserts that the action is right if it confirms the fairness in the distributive,
retributive dimensions of cost and rewards. The distributive dimension means the perceived fairness
in the distribution of social benefits and burden among the group members. The retributive dimension
considers the punishment proportionate to the extent of the crime while the compensatory dimension is
the way people are compensated in relation to the injuries inflicted upon them.

Types of Virtue Ethical Theories:

self 1. Individual Character Ethics – it holds that the identification and development of noble human traits help in
←

determining both the instrumental an intrinsic value of ethical interactions. These noble traits are
courage, self-discipline, prudence, gratitude, wisdom sincerity, understanding, benevolence etc.
at work 2. Work Character Ethics – The identification and development of reflective practitioner noble traits at work
4-

such as creativity, honesty, loyalty, honor, trustworthiness, civility, dependability, shared work pride,
empathy, etc. which determine the intrinsic and instrumental ethical quality of work life.
public service for 3. Professional Character Ethics – holds that self-regulation, loyalty, impartial judgments, altruism,
4-

the
community truthfulness, public service determine the intrinsic and instrumental ethical quality of an individual
associated with communities.

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 Types of System Development Ethical Theories:
continuous improvement 1. Personal Improvement Ethics – the action is good if it is intended to promote the individual’s
←

personal responsibility for the continuous learning, improvement, holistic development and moral
excellence. Example: continuing education program
for the betterment of the 2. Organizational Ethics – action is right if it confirms the development of the formal and informal
←

organization
organizational processes which in turn enhances the procedural outcomes, respectful caring,
innovation in ethical work culture and systematic justice.
for the benefit of
the 3. Extraorganizational Ethics – the action is right if it promotes collaborative partnerships and respect the
←

organization and
other partners
global and domestic constituencies representing the diverse political, economic, legal, social, ecological
)
( applicable to couturier too
and philanthropic concerns that affect the organization.
,

La global cooperation

Other ethical theories

depends
on one 's ←
Subjective Relativism:
beliefs o Relativism:
• No Universal norms of right and wrong.
• One can be wrong or right based on relative views.
o Subjective Relativism:
• Right and wrong for each person are decided by themselves.
• What’s wrong for someone may be right for someone else.
o Case for subjective relativism:
• There can be disagreements on moral issues. (example: abortion)
• Ethical debates are disagreeable and pointless.
o Case against subjective relativism:
• Blurs line between doing what one thinks is right and what they want to do.
• Makes no moral distinction between actions of people.
• Decisions may not be based on reason.
• Subjective relativism and tolerance are two different things.

depend on time ←
Cultural Relativism: -
amustuse intelligent obedience
and place
o In A Nutshell:
§ “Right” and “wrong” depends on a society’s moral guidelines.
§ Guidelines vary from a place to place and from time to time.
§ An action can be right in a certain society at one time and wrong in another society or at another
time.
o Case for cultural relativism:
§ Different social contexts demand different moral guidelines.
§ It is arrogant for one society to judge another.
o Case against cultural relativism:
§ Two societies having different moral views doesn’t mean they’re ought to have different views.
§ Doesn’t explain how moral guidelines are determined.
§ Doesn’t account for evolution of moral guidelines.
§ Provides no way out for cultures in conflict
§ Existence of many acceptable practices doesn’t mean all practices are acceptable.
§ What if there are no cultural norms?
§ Societies share certain core values.
§ Only indirectly based on reason.

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Divine Command Theory: not applicable to all religions ; based obedience met
on
argument of those against
,
reason -0

o Overview:
§ Good actions: aligned with God’s will.
§ Bad actions: contrary to God’s will.
§ Holy books reveal God’s will. We should use them as moral decision-making guides.
o Case for:
§ We owe obedience to our creator.
§ God is all-good and all-knowing. omni benevolent
→ omniscience and

§ God is the ultimate authority.

o Case against:
§ Different holy books disagree on certain teachings.
§ Society is multicultural. Secular.
§ Some modern moral problems not directly addressed in scripture.
§ “The good” != “God”.
§ Based on obedience, not reason.

Kantianism: Immanuel
→ Kant

o Critical importance of good will:

§ Good will: The desire to do the right thing.
§ Immanuel Kant: Only thing in the world that is good without qualification is good will.
§ Reason should cultivate desire to do the right thing.
• “What we want” vs “What we ought to do”
o Categorical imperative:
§ Stuff:
• Moral value of an action depends on the underlying moral rule.
• Our actions should be grounded by an appropriate moral rule.
• What makes a moral rule appropriate?
• Kant proposed the Categorical Imperative.
§ Categorical Imperative (1st formulation):
• Act only from moral rules that you can at the same time will to become universal moral
laws.
o i.e. For it not to have contradictions.
o Example: Making a promise with the intention of breaking it later.
o Which is flawed.
§ Categorical Imperative (2nd formulation):
• Act so that you treat both yourself and other people as ends in themselves and never
only as a means to an end. met people to reach your goal
- a do me

§ Perfect and imperfect duties: →

veracity
• Perfect duty: Duty obliged to fulfill without exception. (Example: Telling the truth)
• Imperfect duty: Duty obliged to fulfill in general but not in every instance.
(Example: Helping others)
§ Case for:
• Rational.
• Aligns with common moral concern.
o What if everyone acted that way?
• Produces universal moral guidelines.
• Treats all persons as moral equals.

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C h a p te r 2 : E th ic a l T h e o r ie s
 prioritization basis of Natural
→ higher ; Law

§ Case against:-7 Non Mali fiance

Autonomy vs .

• Sometimes no rule can adequately characterize an action.

• Sometimes there is no way to resolve conflict between rules.
o In a conflict between a perfect and imperfect duty, perfect duty prevails.
o In a conflict between 2 perfect duties. No solution.
• Kantianism allows no exceptions to perfect duties.

ON VIRTUE ETHICS
Virtue →
developed
overtime

Refers to excellence in character. Virtues are thought of as purposive dispositions and character traits that are
developed throughout life. These are praiseworthy traits of human character. Schools, social institutions, and
familieshelptoshapeaperson’smoral character.

Virtue Ethics →
proposed by Aristotle ; humans are social and prettied animal
Deals with questions such as, “What sort of person must I be?” and “What makes an individual a good or virtuous
person?” rather, than “What is right or good to do?” When people practice virtue ethics, they do not use universal
rules or principles to guide their actions. Rather than focusing on what is right or wrong, virtue ethics is based on the
excellence of one’s character and the consideration of what a person wants to become.

Historic Influences and Tradition

The origin of virtue ethics is associated with the ancient Greeks, most notably Plato and Aristotle. In Eastern
philosophy specifically in Buddhism, virtue ethics is valued. Likewise, in nursing, virtue ethics is valued as manifested
in the works of Florence Nightingale.

Virtues in Bioethics
Virtues are the character of the health care provider, which are morally praiseworthy traits. These characters are
immeasurable, when these virtues are cultivated into a nurse. Personality; it is believed that that he/she can grow
into a compassionate, humble, courageoushealthcareprofessional with integrity.

Professional Virtues
Purity and holiness have religious overtones but these are embodied in The Hippocratic Oath. In nursing, to maintain
purity and manifest a holy disposition is also important. The following Codes of Ethics for Nurses have implied
statements:

The nurse at all times maintains standards of personal conduct which reflects well on the profession and enhance
public confidence” (International Code of Ethics for Nurses)

The nurse owes the same duties to self as to others including the responsibility to preserve integrity and safety…”
(American Nurses Associations Code of Ethics, approvedJune30, 2001)

“[Nurses must] perform their professional duties inconformity with existing laws, rules, regulations, measures, and
generally acceptable principles of moral conduct and proper decorum.” (Code of Ethics for Filipino Registered Nurses)
The above statements imply that virtues in nursing are important in order to act based on social values and needs,
astheyareappliedtorealitiesof healthandnursingcareinachangingsociety.

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C h a p te r 2 : E th ic a l T h e o r ie s
Secular Virtues
According to Plato, the four classical Greek virtues which are found to be praiseworthy are: justice,
temperance, courage, and wisdom. These virtues enable the nurse to be firm in facing adversity, intactness of
character, to be kind and optimistic, and to experience great joy in serving.

Religious Virtues
Roman Catholics tend to affirm both Greeks and Christian virtues, thus having a full list of seven virtues (namely
prudence, justice, temperance, fortitude, faith, hope and love); while Protestants, being more prone to see tension
between the Greeks and Christians, often limit their list to the three Pauline virtues such as faith, hope, and love
(agape or charity). In addition to the Biblical Christian virtues, other major religions also put forward virtue
lists such as contentedness, gratitude, generosity, and magnanimity from among the Muslims. The ancient Hindu
Caraka Samhita lists care, attention, humility, and constant reflection. The famous Confucian virtues are humaneness,
compassion, and filial piety. Filial piety is important in ancient Chinese medical ethics. It has been seen as implying
that Chinese physicians are ideally like family member treating patients as brothers rather than the more distant
“professional” relation that is the norm in Western culture.

Virtue- Based Nursing Model

The Moral Ground Model has its foundation in Aristotle’s approach to ‟virtue ethics with a proposed path to moral
ground adapted from the Eightfold Path of Buddhism. Both the ethics of Aristotle and Buddhism are teleological
philosophies,meaningthattheybothfocushumanmoralityonmovingtowardafinalpurposeorgoal.Themodelimpliesthat
as nurses go about in their day-to-day activities, they are aware that this routine may give them dissatisfaction from
their profession. But nurses are also aware that they have to focus less on their dissatisfaction instead, they need to
carry on with their work. The following activities and attitudes will develop the nurses
‟intellectual and moral virtues which could facilitate growth in her character as a person and as a nurse in the
profession:

Insight (sophia)
Sophia is translated as wisdom. This is the ability to think well about the nature of the world, and it involves careful
deliberation of universal truths. The nurse’s sensitivity to the situations ‟ofpeoplearoundhercanmakeherlearn from
their experiences. Remaining open to learning can educate nurses about intellectual virtues that provide insight
into the nature of reality, which could shape them to become practically wise.

Practical wisdom (phronesis)

a common sense
✓

Phronesis is sometimes translated as prudence. It is the capability to consider the mode of action in order to deliver
change, especially to enhance the quality of life. It involves using one’s insight into reality in deliberatively reasoning
and applying ‟the intellectual virtue of practical wisdom in directing ones ‟actions. It includes knowing how a
person of virtue chooses to act. Nursesareexpectedtobeprudentatall times. He/she could exercise prudence by
careful analysis of the actions and the decisions that he/she makes especially in rendering care to clients.
Inability to be prudent could lead to situations involving negligence or malpractice.

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C h a p te r 2 : E th ic a l T h e o r ie s
 Choice (prohairesis)
Morality is achieved through choice (prohairesis), facilitated by insight, practical wisdom, and evenness of
emotional states. Moral virtues and the excellence of the nurses ‟disposition, or character, are cultivated through
habitual practicesuchaseffectivecommunicationandcompassionate caring.

Goal or telos
It embodies personal and professional excellence in nursing which is characterized as active happiness and well-being
that is consistent with an enlightening awareness of the causes of moral suffering as well as the awareness of the
sacredness of the day to day moral nature of nurses’ work.

Virtues of the Health Care Provider

standard operating procedures
← • Fidelity
to the
prevent harming patients Refers to the obligation of a person to be faithful to agreements, responsibilities, and commitments that he
has made to himself and to others. It is the main principle that supports the concept of accountability of
nurses and other professionals.
truth -

telling
is a
←

perfect duty
• Honesty
Being fair and just in character and behaviour, not cheating or stealing, free of deceit. This is synonymous
with sincerity, integrity, truthful, uprightness, and just. Honesty to self and in the performance of duty is
expected from the nurse.
• Humility
This is defined as being modest in dealings, unpretentious, with simplicity, and submissive. Nurses are
known for this virtue as they perform their role as a member of the health care team.
respect hierarchy ←
• Respect
This is showing a deferential esteem felt or shown toward a person. Nurses do not only show this virtue to
the patients but to the other members of the health team, community, and society, or in any setting that
she is involved.
• Compassion
This is a virtue that is important for the nurse because this enables her to serve others selflessly.
• Prudence
This is described as acting with cautiousness, with foresight, and with discretion. A nurse is expected to be
prudent in all that she does, especially in the performance of her duty.
• Courage
This is the ability to disregard fear in acting out one’s convictions and belief. There are also times in a nurse’s
career when he/she ‟becomes physically and emotionally exhausted and yet, somehow, finds the strength
to go on. Nurses have to muster up strength and persevere to be able to perform their duties and
responsibilities.

Habits of the Health Care Provider

The Good Habits
• Be Proactive - the proactive habit can be applied in multiple ways to foster healthcare interoperability. This
is acting in a flexible manner in order to perform better and achieve more. This could be done in the
communication of patient data through the use of information technology. Being proactive in healthcare
results to:

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C h a p te r 2 : E th ic a l T h e o r ie s
 1. Adaptability –being flexible to adapt to the various data requirements
2. Independence–removing total reliance to others to achieve your objectives
3. Satisfaction –delivering responsive clients service ‟With a proactive mindset and approach,
there is interdependenceamonghealthcareprovidersinhealthcaredelivery.

• Begin with the End in Mind

Knowing what you want to achieve for your practice is important in deciding what integration approach
should be taken. With better service as the vision, the health care delivery goals are better achieved. As a
health care provider, the nurse’s involvement could ‟increase the efficiency of service. These could be
through collaboration with the other members of the health care team, and the integration of technology in
the different departments and levels of care.

• Put First Things First

The patient is first. Delivering high quality patient care in a timely and accurate manner is fundamental. What
helps facilitate putting patients first? There are many answers to this question. Having the right
physicians, nurses, and other personnel is an essential part of the formula. Having the right facilities and
equipment is a vital part of the formula. Having the right systems, applications, and ways to connect them is
an integral part of the formula. While the quality of care is largely determined by human hands, an expert
mind and a caring spirit also.

• Seek First to Understand, Then to be Understood

Many times, we jump to what we need, rather than listening to what our patients are requesting. A simple
question to ask is, to gain greater understanding should be “What are you going to do with the information
that I gave you?” Understanding what our patients need, rather than assuming, is imperative.

• Synergize
What does synergize actually mean? Another term for synergy is alliance. In the healthcare environment,
instead of treating each party as a department, it may be better to treat them as alliances. For alliances to
work, everyone involved needs to work together. That is the point of synergy, and it is necessary to
make connected, healthcare initiatives to work and be effective.

• Sharpen the Saw

If there is only one thing that we can do in our life or in our organizations, it should be to look continuously
for ways to improve. Whether it is in our client relationships, the way we solve our problems, or the way that
we approach solutions, keeping our eyes open to new ways on how do things is a must. This process of
renewal will keep progress moving forward. To achieve healthcare interoperability in our communities,
continuous improvement is a must, because (if for no other reason) there are so many changes to which
we need to adapt. There is a simple choice—adapt and improve or maintain the status quo and keep the
paper flowing. The improvements can be realized through many different resources. From workshops and
trade shows to case studies, white papers, and blogs, there are many different avenues to continue to grow
and adapt. Also, there is simple interaction—talking with people from similar or different organizations
to gain their perspectives can open the thought process. Setting aside the time to learn and improve is the
first step

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C h a p te r 2 : E th ic a l T h e o r ie s
Vices of the Health Care Provider
Vices are defects of one’s character or behaviour. Most, but not ‟all virtues are considered a mean between two
kinds of vices, involving either an excess or a deficiency. For example, Aristotle named courage as a virtue, the excess
of courage is rashness, and the deficiency of courage is cowardice. Another example is truthfulness; the excess is
imposture, and the deficiency as self-deprecation.

• Fraud
This is a criminal deception using false representations to gain an unjust advantage. This could be
synonymous with cheating, deceit, swindling, counterfeit, forgery, falsification, double-dealing. Nurses
could fall into such situations when he becomes an accomplice to such circumstances or practices such
actions.

• Pride
A high or overbearing opinion of ones worth or importance. ‟Nurses could at times exhibit such attitude
over their achievements, or feeling of elation or satisfaction of achievements, qualities, or possessions, over
individuals or other professionals. Example: Senior healthcare providers should act as mentors to the
younger ones, but sometimes they are not as accommodating as expected.

• Greed
This is described as the excessive desire especially for food or wealth. Nurses could be put to trap in situations
such as greed for power, position and material wealth.

In conclusion, literatures reveal numerous ethical theories that help us determine the goodness and
badness of human actions especially in the face of an ethical dilemma. Some theories offered clarity while some
offered more confusions. It is good to understand each ethical theory which philosophers contended based on their
understanding of the things of this world. We also carefully reflect on the weakness of each theory. In the end, what
we really need to develop is a set of objective and sound ethical criteria that will enable us to achieve clarity in
terms of ethical judgment and sound ethical decision making while developing the necessary virtues to help up
choose and act firmly on such ethical decisions.

Formative Assessment for TAL students:

Choose 2 scenarios below and apply a particular ethical theory that can help you determine the good things to do.
10 points each

1. A young woman asking for abortion because she is not ready for a baby and has no job. – you believe in the
inviolability of life yet you also understand the young woman’s predicament on raising the child and
respects her autonomy.
2. A woman with congestive heart disease pregnant, being asked to terminate pregnancy but wants to
deliver the baby to full term despite the risk on her part. – you respect the patient’s autonomy and also
believes in the inviolability of life yet you also recognize the risk and harm the patient is facing due to her
pregnancy,

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C h a p te r 2 : E th ic a l T h e o r ie s
 3. A cancer patient in pain asking for more morphine despite being given already the prescribed dosage. – you
understand the suffering of the patient but you also recognize that harm that morphine can do and
can’t do on terminal pain.
4. An old couple wanting for a designer baby – you believe in the natural law yet you also recognize the longing
of the old couple to have a child of their own liking.
5. A middle age couple, childless, wanting for surrogate mother to carry their child. – you believe in the natural
law yet you also understand the longings of the middle age couple to have a child.
6. A young man selling his kidney so he can support his ailing child. – you believe in the principle of totality yet
you also understand the young man’s needs to support his family.
7. A young man choosing sex reassignment surgery because he doesn’t want to live any longer as a man. – you
believe in the natural law yet you also believe in respecting the autonomy/freedom of choice of the young
man.
8. You want to pass the summative exam to maintain your scholarship, but you did not study, then here comes
your classmate offering help by sharing her answers. – you believe in the principle of veracity that supports
truth regarding your capacity yet you also do not want to fail the summative exam and lose the scholarship.

RFERENCES:

Edge, R. & Groves, J. (2019) Ethics of Health Care: A Guide for Clinical Practice. 4th ed. Philippine Edition: Cengage
Learning Asia Pte. Ltd.,.

Monge, M. (2014) Ethics in Medical Practice: Summary, Explanation & Defense of Concrete Ethical
Problems. Revised Edition. Manila: Sinagtala Publishers

Ocampo, M. L. R. (2018) Ethics Primer A Young Person’s Guide to Moral Reasoning. Vibal Group, Inc. Rice, C.

(1996) 50 Questions on the Natural Law: What It Is & Why We Need It. Ignatius Press,

Scgreccia, E. (2012) Personalist Bioethics: Foundations and Applications (T. Di Camillo, J. & Miller, M.
Translation). The National Catholic Bioethics Center. 2007, 1998, 1994, 1988

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C h a p te r 2 : E th ic a l T h e o r ie s
 HISTORY OF BIOETHICS
Geraldine S. Canete, MAN, RN

Born in the Bioethics is derived from the two words bio (life) and ethocs (behavior). To study the behavior of human
4. life comes under the umbrella of bioethics.
V. s .

refers to moral issues and

"

problems survival of science of scientific

knowledge
"
that have arisen
p Bioethics
is a
→ use

as a result of modern and in

safeguarding social good
medical research
Till 1970s the term bioethics was not take until the scientist Van Renssealaer Potter used the term
life and to limit science for the
-
issues are
usually bioethics for the first time in 1971. He is a medical oncologist who defines bioethics as a combination of good of
death humanity
.
can be personal organizational
, , biological knowledge and human values.
institutional ,
or worldwide

Bioethics was born as a response to scientific and social progress. Such progress resulted to threatening
conditions and critical concerns that also raised doubts about human’s ability to survive.

$ The turning point was when the medical profession had to confront new questions, raised directly as a
result of extraordinary progress being made in biomedical sciences.

Threatening conditions in history

- Several highly publicized abuses in the field of human experimentation

1930 -1970 - Tuskeegee, Alabama, US Gov’t had syphilis experiment among 400 Black Americans
(1947) who were not treated despite the discovery of penicilin →
they were
studying the
progress of syphilis

1947 - Nuremberg Code. Condemned all experimentation on human subjects without their consent in
response to Nazi’s experiments. -
a experiments done on Jewish people by the Nazis

1963 - tumor cells were injected without consent to elderlies at the Jewish Chronic Disease Hospital in
Brooklyn New York

1965-1971 - Studies on viral hepatitis immunization at Willowbrook State Hospital in New York where
handicapped children were inoculated with the virus.

Discoveries in genetic engineering which brought the potential for manufacturing biological weapons and
altering the very constitution of life forms, species and individuals. BEFORE BIOETHICS

survival of the fittest

• Superman mentality is useless
.

weakness
• Critical Concerns ,
,

• Human experimentation -

Rights of the strong was confronted by group of the weak

• The discovery of genetics -

However , Superman mentality didn't
manage to produce the
infinity
• Organ Transplants >
Bioethics came to
fight the era where rights are subordinate to
• The beginning of life and human procreation strength
• End of life issues

Changes that gave birth to the need for Bioethics

The following changes gave rise to the need of bioethics:
1. because of perennial issues, dilemmas & problems
2. because of legal dimension- To address legal problems in health care with ethical concerns
3. Emergence of ethical practice in health care
4. to provide awareness to the health team of the dos and don’ts of nursing practice

1
Chapter 3: History of Bioethics
 5. To enrich one’s competence by understanding that the patient is a person and holistic individual
6. To make clear to us why one act is better than the other
7. Enable us to live and have an orderly social way of life
8. Scientific Advances
9. Inequalities in socio-economic, educational and political positions
10. Finitude of resources
11. Changes in the doctor-patient relationships
12. Rampant unethical behavior

DEVELOPMENT OF BIOETHICS
Individual scholars began to legitimize bioethical issues as questions deserving rigorous academic study.
But bioethics solidified itself as a field only when it became housed in institutions dedicated to the study of
these questions.

The first institution devoted to the study of bioethical questions was a freestanding bioethics center,
purposely removed from the academy with its rigid demarcations of academic study.
first bioethics center
Tx
The institution was the Hastings Center, originally called The Institute of Society, Ethics and the Life
Sciences, which opened its doors in September 1970.

• 1969: HASTING’s CENTER – founded by the Philosopher Daniel Callahan and the Psychiatrist
Willard Gaylin. The purpose was to study and formulate the norms especially in the context of
research and experimentation in the biomedical field. At that time the term bioethics was not yet
used.

• 1970 -1971: Van Rensseler Potter introduced the term bioethics in two publications:
o Bioethics : The science of survival (1970)
o Bioethics : Bridge to the Future (1971)

* According to Potter, Bioethics is broader in scope than traditional medical ethics.

The second institution that helped solidify the field of bioethics was the Kennedy Institute of Ethics,
which opened at Georgetown University in 1971.

• 1970 – ANDRE HELLEGERS – a young obstetrician as an expert in fetal physiology, was asked
in 1971 to direct the KENNEDY Institte for the Human Reproduction and Bioethics of Georgetown
University. Academic bioethics was born with the creation of the "bioethics center.”

He proposed a maieutic (Socratic) dimension of bioethics that understands values by way of the
dialogue and contrast between medicine, philosophy, and ethics which paved the way for an
interdisciplinary method.

The objective of bioethics he identified is the ethical aspects implicit in clinical procedures.

Hence bioethics became ethics applied to biomedicine which is a restricted scope as compared
to Potter. But maintained that the direct study of biological problems causes ethics to progress
and that the clinical bioethicists are more expert than the traditional moralists.

2
Chapter 3: History of Bioethics
From these modest beginnings, the field of bioethics exploded, with dozens of universities following suit,
creating institutions whose sole function was the study of bioethical issues.

Bioethics was now permanently on the academic map and central to public discourse.

INTERPRETATIONS OF BIOETHICS:
“The systematic study of human conduct in the area of life sciences and health care, in so far as
this conduct is examined in the light of moral values and principles.” (W.T. Reich, Encyclopedia of
Bioethics, 1978)

“The systematic study of moral dimensions – including the moral visions, decisions, conduct and
policies etc – of the life science and healthcare, employing a variety of ethical methodologies in an
interdisciplinary setting.” (Reich, Encyclopedia of Bioethics, 1995, 2004)

On pluralistic bioethics that is also relativistic: This new discipline cannot be understood as a simple
comparison of the different opinions and the various positions that exists; rather it must propose
standards, values and effective decision-making approaches providing objective answers based on
rationally valid criteria.

The search for adequate answers demand an interdisciplinary approach to the problem, which is one of
the unique characteristics of bioethics.
study of
'
the humans limit in
p knowledge

“A discipline with a rational epistemiological status that is open to theology, which is understood
as a separational science, the ultimate authority and the horizon of meaning. Starting from the definition,
description of the scientific, biological and medical data, bioethics rationaly examines the liceity of man’s
interventions on man.” (Sgreccia, L. Personalist Bioethics, 2014) legitimacy lawfulness
an

BIOETHICS AS THE CRITICAL CONSCIENCE OF TECHNOLOGICAL CIVILIZATION

From this perspective, bioethics is configured as a philosophical activity, regardless of who is
actually conducting the inqury, because questions (the formal object) encountered by the technological
sciences (material object) are by nature philosophical and concern the significance of how human identity
is construed within the technological activity. (Pessina, A, Bioethica: L’ uomo Sperimentale)

Four Areas of Bioethics Competency

1991 - The ERICE Document
• Refers to the contents of the 1978 Encyclopedia of Bioethics and recognize four areas in
which bioethics has competence.
1. Ethical problems in the health care profession.

2. Ethical problems arising in the field of human research even if it’s not directly therapeutic.

3. Social problems connected with national and international public health policies with health care
jobs and with family planning and population control policies.

4. Problems related to interventions on the life of other living things. (plants, microorganisms and
animals) and generally to anything having to do with the equilibrium of the ecosystem.

3
Chapter 3: History of Bioethics
 SUBDIVISIONS OF BIOETHICS
• General Bioethics: Ethical formulations, discussion of values and first principles, documentary
sources of bioethics.
• Particular Bioethics: Analyze the major problems always a s part of the general approach bot in
the medical field and in biology (genetic engineering, abortion, euthanasia, cloning. Artificial
fertilization etc.)
• Clinical Bioethics: Application of ethical theories and accepted general principles to concrete
clinical cases seeking guidelines of actions.

* REMOTE SOURCES OF BIOETHICS

• The Hippocratic Oath and writings:
o Do no harm and paternalism
o Foundation of medicine
• Greek Philosophers
o personhood & virtues behavior Hippocrates (5th cent. B.C.) Hippocratic Oath – “first do no
harm”
o “and abstain from whatever in deleterious & mischievous. I will give no deadly medicine
to any one if asked, nor suggest any such counsel; & in like manner I will not give to
woman a pessary to produce abortion.”
• Christianity – Middle Ages
o Foundation of the concept of person
o Theological significance of Care
• Oath of Maimonides (1200)
o Look upon the sick with empathy & respect
o Accept teaching of elders with med skills
o Work for the benefit of the mankind

• 18th century
Particularly in Britain, the emphasis in medical ethics centered on proper, honorable behavior.

o "Medical Ethics" and "A Code of Institutes and Precepts" by Thomas Percival. Percival’s
Code 1794. 1st code of medical ethics adopted by group of professional physicians.
American Medical
o Association Code - Duties & obligations of physician to pts & to the society & the field of
medicine
o American physician Benjamin Rush, a signer of the Declaration of Independence, was
promoting American medical ethics.

RECENT SOURCES OF BIOETHICS

• Nuremberg Code (1947) condemned all experimentation on human subjects without their
consent. Alarm caused by several experiments in the USA – Tuskegee Experiment for Syphillis,
The Jewish Chronic Disease Hospital in Brooklyn experiment on tumor cells injected to elderly
patients, the Willowbrook State Hospital experiment in New York on injecting hepatitis virus
injected on handicapped children with consent coerced from parents.
• World Medical Association – HELSINKI Declaration on clinical experimentation

4
Chapter 3: History of Bioethics
THEOLOGICAL PRESUPPOSITIONS
1. The Dignity of the Human Person– unitotality of body and spirit and from faith perspective,
image of God.
2. Realism, Cognitism– the human person has the rational ability to know reality and the structure
of values (denial denial of relativism and nihilism)
3. A metaphysical view of reality – the human intellect is able to move from phenomenon to
foundation and to understand what ought to be from what is, it is necessary to vindicate the
human beings capacity to know the transcendent and metaphysical dimension in a way that is
true and certain, albeit imperfect and analogical (Fides et ratio, 1983, cited in Sgreccia, 2014)

RECENT HISTORICAL LANDMARKS

• NATIONAL RESEARCH ACT 1974
- National Commission for the Protection of Human Subject of Biomedical & Behavioral
Research BELMONT REPORT 1979
• 3 fundamental principles of biomedical research ethics: Respect for persons, Beneficence,
Justice
• Importance of INFORMED CONSENT

EVENTS INFLUENCING THE DEVELOPMENT OF BIOETHICS

• Artificial heart transplantation
o 1960 Dr. Denton Cooley’s artificial heart - w/o proper ethical & regulatory overview
o 1980: Dr. Copeland – quality of life
• Xenotransplantation – non human to human pi who
gets to the
use first
machine

o 1960: Kidney Dialysis machine: “God Squad” – based from value – laden, social worth
• New definition of Death by Ad Hoc Committee at Harvard University 1968 → when to harvest the
organs for donation

• Discussion of Demographic Explosion population control

→

• Contraceptive pill by Gregory Pinkus

• Humanae Vitae 1968 published by
→ Catholic church about
the humans should
how be
treated amidst
nientific advancement
• Dramatic Shift to civil liberties and individual rights (1960 & 1970s)
• Women demanded greater Privacy in Reproductive Decisions Patients demanded control over
their treatment decisions Artificial Reproductive technology End of Life Issues:
• Patient Self Determination Act of 1991
• Advance directives & living will
• Right to Die Movement
• Oregon Death Dignity
}
to assure the
autonomy of the patients

In view of how Bioethics developed throughout history, Bioethics emerged truly as a new type of
wisdom. Potter (1970) considered bioethics as a new type of wisdom that would have to know how to use
scientific knowledge in order to safeguard the social good. With all the happened throughout history,
Bioethics indeed is a science of survival not only aimed solely of studying and explaining natural
phenomena but also discovering how to wisely use technological and scientific knowledge so as to foster
the survival of the human good, the human species and improve the quality of life of future generations.

According to Potter, the only possible way of preventing catastrophe was to bridge between the
two cultures, one scientific and the other humanistic and moral, otherwise indiscriminate scientific and
technological process will endanger humanity and the very survival of life on earth. Moreover, Potter
suggests that bioethics should focus not only on Man but also on the biosphere in its entirety addressing
every scientific intervention by human persons/beings upon life in general.

5
Chapter 3: History of Bioethics
REFERENCES:

Edge, R. & Groves, J. (2019) Ethics of Health Care: A Guide for Clinical Practice. 4th ed. Philippine
Edition:
Cengage Learning Asia Pte. Ltd.,.

Monge, M. (2014) Ethics in Medical Practice: Summary, Explanation & Defense of Concrete Ethical

Problems. Revised Edition. Manila: Sinagtala Publishers

Ocampo, M. L. R. (2018) Ethics Primer A Young Person’s Guide to Moral Reasoning. Vibal Group, Inc.

Rice, C. (1996) 50 Questions on the Natural Law: What It Is & Why We Need It. Ignatius Press,

Scgreccia, E. (2012) Personalist Bioethics: Foundations and Applications (T. Di Camillo, J. & Miller, M.
Translation). The National Catholic Bioethics Center. 2007, 1998, 1994, 198

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Chapter 3: History of Bioethics