BIOETHICS

OBJECTIVES

• TO APPLY THE PRINCIPLES OF THE DECLARATION OF UNESCO ON CLINICAL

CASES
• TO CORRELATE ETHICAL APPROACHES TO DOMESTIC LAWS
• TO DISCUSS SPECIFIC PRINCIPLE/S INVOLVED IN THE CASES
1. WHAT IS BIOETHICS?
• THE WORD BIO REFERS TO LIFE WHILE THE TERM ETHICS ORIGINATED
FROM THE GREEK WORD ETHOS WHICH MEANS HUMAN BEHAVIOR
• BIOETHICS REFERS TO HUMAN BEHAVIOR IN RELATION TO LIFE
• PRACTICAL SCIENCE OF MORAL BEHAVIOR TOWARDS LIFE
• DEALS WITH MORAL BEHAVIOR AS IT DIRECTS ACTIONS ONE “OUGHT TO
DO” RATHER THAN WHAT ONE “CAN DO”
• IT RELATES TO LIFE BECAUSE IT PERTAINS TO PERSONS AS LIVING BEINGS
2. WHAT IS THE ROLE OF
BIOETHICS IN OUR LIFE
TODAY?
 BIOETHICS ASSUMES ITS ROLE IN:

• HELPING PEOPLE UNDERSTAND MORAL ISSUES TOWARDS LIFE

• PROVIDING INSIGHTS IN DEALING WITH REAL-LIFE SITUATIONS:
ONE’S OWN LIFE AS WELL AS THE LIFE OF OTHERS
• PUTTING VARIOUS CONSIDERATIONS INTO THEIR PERSPECTIVE
 3. HOW DOES BIOETHICS
DIFFER FROM MORALITY,
PROFESSIONAL ETHICS, LEGAL
ETHICS, OR HEALTH ETHICS?
• MORALITY
• PRINCIPLES CONCERNING THE DISTINCTION BETWEEN RIGHT AND
WRONG OR GOOD AND BAD BEHAVIOR.
• SPEAKS OF A SYSTEM OF BEHAVIOR IN REGARDS TO STANDARDS OF
RIGHT OR WRONG BEHAVIOR.
• THE WORD CARRIES THE CONCEPTS OF: (1) MORAL STANDARDS, WITH
REGARD TO BEHAVIOR; (2) MORAL RESPONSIBILITY, REFERRING TO
OUR CONSCIENCE; AND (3) A MORAL IDENTITY, OR ONE WHO IS
CAPABLE OF RIGHT OR WRONG ACTION.
• BIOETHICS IS THAT PART OF MORALITY RELATES TO LIFE
• PROFESSIONAL ETHICS FOLLOWS THE DICTATES OF THE
PROFESSION
• LEGAL ETHICS FOLLOWS SECULAR LAW
• HEALTH ETHICS DEALS WITH HEALTH
4. WHAT IS A BIOETHICIST?
HOW CAN BIOETHICS BEST
BE LEARNED/TAUGHT?
 BIOETHICIST
• ANALYZES ETHICAL COMPONENTS OF REAL OR POTENTIAL HEALTH CARE
ACTIONS/DECISIONS, AND PROVIDES AN ETHICAL JUSTIFICATION SUPPORTING
SPECIFIC ACTIONS OR DECISIONS.
• MAY BE CONSULTED IN CASES WHERE THERE IS UNCERTAINTY ABOUT THE
RIGHT COURSE OF ACTION FOR A PATIENT DUE TO CONFLICTING VALUES.
• USUALLY HAS AN ADVANCED DEGREE IN A FIELD SUCH AS PHILOSOPHY,
MEDICINE, NURSING, SOCIAL WORK, GENETICS, OR LAW, AND MAY ALSO PURSUE
SPECIFIC ADVANCED DEGREES OR CERTIFICATION COURSES IN BIOETHICS.
• BECOMES INVOLVED IN A PATIENT’S CARE AT THE REQUEST OF ANOTHER
MEMBER OF THE HEALTH CARE TEAM, THE PATIENT, OR FAMILY MEMBERS.
 BIOETHICIST

• ONE WHO SPECIALIZES IN BIOETHICS

• ONE WHO BEHAVES ETHICALLY, ONE WHO LIVES OUT
HIS/HER BIOETHICIST IDENTITY IS A TRUE BIOETHICIST
 5. HOW CAN BIOETHICS BEST BE
LEARNED/TAUGHT?
• KNOWLEDGE OF CONCEPTS, PRINCIPLES, THEORIES AND
ISSUES CAN BE OBTAINED BY READING AUTHORITATIVE
MATERIALS, ATTENDING CONFERENCES, SEMINARS AND
COURSES, AND OBSERVING AND PARTICIPATING IN
ETHICAL ACTIVITIES
6. WHO DETERMINES AN
ACTION TO BE ETHICAL?
HOW?
• THERE ARE STANDARDS THAT DETERMINE WHAT IS RIGHT AND WRONG
• CONSEQUENCES OF ACTION
• COMPLIANCE WITH ONE’S DUTY OR OBLIGATION
• PRINCIPLES
• A VIRTUOUS PERSON’S CHOICE
• JUDGEMENT ON PREVIOUS SIMILAR ACTIONS
• COMMON GOOD
• ANYONE WHO CONSCIENTIOUSLY AND OBJECTIVELY APPLIES THESE
STANDARDS/NORMS CAN DETERMINE AN ACTION TO BE ETHICAL
• HE/SHE USES HIS/HER WELL-DEVELOPED CONSCIENCE TO CONSIDER THE
OBJECT, MOTIVE AND CIRCUMSTANCES OF AN ACTION
• ANYONE WHO CAN DECIDE AND ACCEPT THE CONSEQUENCES OF HIS/HER
DECISION
 7. WHAT IS A BIOETHICS
COMMITTEE? WHAT IS ITS
PURPOSE?
 BIOETHICS COMMITTEE

• A PERMANENT OR AD HOC BODY AUTHORIZED OR MANDATED TO

SYSTEMATICALLY ADDRESS THE ETHICAL DIMENSIONS OF THE HEALTH
SCIENCES, THE LIFE SCIENCES, AND INNOVATE HEALTH POLICIES
 PURPOSE

• PROTECT A COMPETENT PATIENTS’ DECISIONS

• ENSURE/IMPROVE THE WELL-BEING OF A PATIENT (PATIENT-CENTERED CARE)
• GUARD HEALTHCARE INSTITUTIONS AND THOSE WHO PRACTICE IN THEM FROM LEGAL
LIABILITY
• ENHANCE PUBLIC BENEFITS
• FACILITATE ACQUISITION AND USE OF NEW DEVELOPMENTS
• SEARCH FOR AN EQUITABLE DISTRIBUTION OF HEALTHCARE RESOURCES THROUGH
EDUCATION, CONSULTATION, AND POLICY DEVELOPMENT/REVIEW
• REVIEW AND APPROVE RESEARCH
• PROMOTE COMMUNITY PROJECTS
8. WHAT CONTROLS ARE
AVAILABLE TO ENSURE
ETHICAL ACTION?
 CONTROLS

• HEALTHCARE PROVIDER
• PATIENT
• FAMILY MEMBER
• RESEARCHER
 THIRD-PARTY SYSTEM CONTROLS

• INTERNATIONAL BODIES
• NATIONAL GOVERNMENT
• PROFESSIONAL SOCIETIES
• INSTITUTIONS
• ETHICS COMMITTEES
 9. WHEN DOES THE
PHYSICIAN-PATIENT
RELATIONSHIP START?
10. CAN A DOCTOR REFUSE
“TO CARE” FOR A PATIENT?
 PMA CODE OF ETHICS OF THE MEDICAL
PROFESSION
• ARTICLE II – DUTIES TO PATIENTS
• SECTION 2. RECOGNIZING THAT THE PATIENT HAS THE RIGHT TO CHOOSE HIS
PHYSICIAN, THE PHYSICIAN IS LIKEWISE UNDER NO OBLIGATION TO ACCEPT ANY
PATIENT. IF HE CANNOT CARE FOR THE PATIENT HE SHOULD GUIDE THE PATIENT OR
HIS FAMILY ON WHAT TO DO.
 BOARD OF MEDICINE CODE OF ETHICS (1965)

• ARTICLE II – DUTIES OF PHYSICIAN TO THEIR PATIENTS

• SECTION 2. A PHYSICIAN IS FREE TO CHOOSE WHOM HE WILL SERVE. HE MAY
REFUSE CALLS, OR OTHER MEDICAL SERVICES FOR REASONS SATISFACTORY TO HIS
PROFESSIONAL CONSCIENCE. HE SHOULD, HOWEVER, ALWAYS RESPOND TO ANY
REQUEST FOR HIS ASSISTANCE IN AN EMERGENCY. ONCE HE UNDERTAKES A CASE,
HE SHOULD NOT ABANDON NOR NEGLECT IT. IF FOR ANY REASON HE WANTS TO BE
RELEASED FROM IT, HE SHOULD ANNOUNCE HIS DESIRE PREVIOUSLY, GIVING
SUFFICIENT TIME OR OPPORTUNITY TO THE PATIENT OR HIS FAMILY TO SECURE
ANOTHER MEDICAL ATTENDANT.
 11. CAN A DYING PATIENT OR
HIS/HER FAMILY DEMAND
TREATMENT THAT A DOCTOR
CONSIDERS TO BE UNACCEPTABLE?
 DYING PERSON’S BILL OF RIGHTS
• I HAVE THE RIGHT TO BE TREATED AS A LIVING HUMAN BEING UNTIL I DIE
• I HAVE THE RIGHT TO MAINTAIN A SENSE OF HOPEFULNESS; HOWEVER
CHANGING ITS FOCUS MAY BE
• I HAVE THE RIGHT TO BE CARED FOR BY THOSE WHO CAN MAINTAIN A SENSE OF
HOPEFULNESS, HOWEVER CHANGING MIGHT BE
• I HAVE THE RIGHT TO EXPRESS MY FEELINGS AND EMOTIONS ABOUT MY
APPROACHING DEATH IN MY OWN WAY
• I HAVE THE RIGHT TO PARTICIPATE IN DECISIONS CONCERNING MY CARE
• I HAVE THE RIGHT TO EXPECT CONTINUING MEDICAL AND NURSING ATTENTION
EVEN THOUGH “CURE” GOALS MUST BE CHANGED TO “COMFORT” GOALS
• I HAVE THE RIGHT TO NOT DIE ALONE
• I HAVE THE RIGHT TO BE FREE FROM PAIN
• I HAVE THE RIGHT TO HAVE MY QUESTIONS ANSWERED HONESTLY
• I HAVE THE RIGHT NOT TO BE DECEIVED
• I HAVE THE RIGHT TO HAVE HELP FROM AND FOR MY FAMILY IN ACCEPTING MY
DEATH
• I HAVE THE RIGHT TO DIE IN PEACE AND DIGNITY
• I HAVE THE RIGHT TO RETAIN MY INDIVIDUALITY AND NOT BE JUDGED FOR MY
DECISIONS, WHICH MAY BE CONTRARY TO BELIEFS OF OTHERS
• I HAVE THE RIGHT TO DISCUSS AND ENLARGE MY RELIGIOUS AND/OR SPIRITUAL
EXPERIENCES, WHATEVER THESE MAY MEAN TO OTHERS
• I HAVE THE RIGHT TO EXPECT THAT THE SANCTITY OF HUMAN BODY WILL BE
RESPECTED AFTER DEATH
• I HAVE THE RIGHT TO BE CARED FOR BY CARING, SENSITIVE, KNOWLEDGEABLE
PEOPLE WHO WILL ATTEMPT TO UNDERSTAND MY NEEDS AND WILL BE ABLE TO
GAIN SOME SATISFACTIONS IN HELPING ME FACE MY DEATH
• EUTHANASIA
• ANTIBIOTICS FOR A PATIENT WITH WIDESPREAD CANCER AND MULTIPLE
IRREVERSIBLE ORGAN DAMAGE
• NEPHROTOXIC DRUG TO BE ADMINISTERED TO A PATIENT WITH RENAL FAILURE
 12. WHAT ARE THE
RESPONSIBILITIES OF A
DOCTOR TO HIS/HER
PATIENTS?
 PMA CODE OF ETHICS OF THE MEDICAL
PROFESSION
• ARTICLE II – DUTIES TO PATIENTS
• SECTION 1. THE PHYSICIAN’S PRINCIPAL RESPONSIBILITY IS THE PATIENT’S WELFARE, BOTH
INSOFAR AS THE STATE OF HIS HEALTH IS CONCERNED, AS WELL AS HIS STATUS AS A HUMAN
BEING DESERVING DIGNITY AND RESPECT.
• SECTION 2. RECOGNIZING THAT THE PATIENT HAS THE RIGHT TO CHOOSE HIS PHYSICIAN,
THE PHYSICIAN IS LIKEWISE UNDER NO OBLIGATION TO ACCEPT ANY PATIENT. IF HE CANNOT
CARE FOR THE PATIENT HE SHOULD GUIDE THE PATIENT OR HIS FAMILY ON WHAT TO DO.
• SECTION 3. IT IS THE DUTY OF THE PHYSICIAN TO INFORM THE PATIENT OR HIS RELATIVES OF
THE NATURE OF THE ILLNESS, PROGRESS OF HIS CONDITIONS, COMMON ACCEPTED
TREATMENT, ALTERNATIVES, RISKS AND PROBABLE COSTS, OBTAIN A VOLUNTARY
INFORMED CONSENT FOR ANY PROCEDURE HE INTENDS TO PERFORM EXCEPT IN
EMERGENCY CASES OR OTHER SITUATIONS.
• SECTION 4. THE PHYSICIAN IS OBLIGED TO RESPECT THE CONFIDENTIALITY OF ALL
INFORMATION HE ACQUIRES ON THE BASIS OF HIS PROFESSIONAL CAPACITY, AND SHALL
NOT DIVULGE THIS INFORMATION TO THIRD PARTIES, UNLESS THERE IS A LAW, A COURT
ORDER, OR A WAIVER FROM THE PATIENT OR WHEN THE COMMON GOOD SO REQUIRES. SUCH
OBLIGATION EXTENDS EVEN AFTER THE DEATH OF THE PATIENT.
• SECTION 5. THE PHYSICIAN IS OBLIGED WITH THE CONSENT OF THE PATIENT TO REFER THE
CASE TO ANOTHER APPROPRIATE PHYSICIAN. WHENEVER THERE IS DOUBT IN TERMS OF
DIAGNOSIS AND TREATMENT OR WHEN THE PATIENT OR FAMILY REQUEST IT, OR IF THE CASE
REQUIRES PROCEDURES FOR WHICH THE PHYSICIAN IS NOT ADEQUATELY TRAINED.
• SECTION 6. THE PHYSICIAN SHOULD BE FAIR AND CONSIDERATE IN DETERMINING HIS
PROFESSIONAL FEE, TAKING INTO ACCOUNT THE COMPLEXITY OF THE CASE, THE DURATION
OF CARE, HIS EXPERTISE, CURRENT FEES AND THE ECONOMIC STATUS OF THE PATIENT.
• SECTION 7. THE PHYSICIAN IS OBLIGED TO UPDATE HIS KNOWLEDGE AND SKILLS SO THAT
HE CAN PROVIDE MEDICAL CARE IN ACCORDANCE WITH CURRENT STANDARDS OF PATIENT
CARE.
• PROVIDE COMPETENT, HOLISTIC, AND HUMANE HEALTH CARE
• CONSIDER THE TOTAL HUMAN PERSON RATHER THAN JUST THE BODY ORGAN OR THE DISEASE
• DISCLOSE TRUTHFUL INFORMATION ABOUT THE PATIENT’S ILLNESS AND THE VARIOUS OPTIONS
INCLUDING THEIR CORRESPONDING BENEFITS AND DISADVANTAGES OR ADVERSE EFFECTS
• SECURE FREE AND INFORMED CONSENT BEFORE PERFORMING ANY PROCEDURE
• MAKE SCIENTIFIC, EVIDENCE-BASED MANAGEMENT DECISIONS: CHOOSE SAFE COST-EFFECTIVE
EXAMINATIONS; AND PRESCRIBE MEDICINE BASED ON RATIONAL DRUG USE PRINCIPLES
• TREAT THE PATIENT WITH FIDELITY, HUMILITY, AND COMPASSION
 13. SHOULD A PHYSICIAN INFORM HIS/HER
PATIENT THAT THE FORMER HAS AN ILLNESS THAT
CAN BE TRANSMITTED? WHICH HAS HIGHER
PRIORITY, THE PHYSICIAN’S PRIVACY OR THE
PATIENT’S RIGHT TO KNOW/NOT TO BE HARMED?
 CONSIDERATIONS

• THE RISK OF TRANSMITTING THE DISEASE

• THE SERIOUSNESS OF THE DISEASE
• THE EFFECT OF THE DISEASE ON THE DOCTOR’S COMPETENCE TO PROVIDE
HEALTH CARE
• THE RISK OF THE PHYSICIAN BETRAYING THE PATIENT’S TRUST
• THE RISK OF DOCTOR AND HOSPITAL LIABILITY
14. WHEN DOES THE
PHYSICIAN-PATIENT
RELATIONSHIP END?
 PHYSICIAN

• PATIENT MUST BE GIVEN NOTICE OF THE PHYSICIAN’S INTENTION TO WITHDRAW

• PHYSICIAN MAY WRITE LETTER OF WITHDRAWAL
 PATIENT

• THE TERMINATION OF THE CONTRACT AND THE CIRCUMSTANCES SURROUNDING

IT SHOULD BE CAREFULLY DOCUMENTED IN THE PHYSICIAN’S RECORDS
• IT MAY BE ACCOMPLISHED BY THE PHYSICIAN’S CONFIRMING THE DISCHARGE
BY A CERTIFIED MAIL LETTER
 15. WHAT ARE SOME OTHER
COMMON UNETHICAL
PRACTICES IN THE PHYSICIAN-
PATIENT RELATIONSHIP?
• TACTLESS, IRRESPONSIBLE COMMENTS AND UNSUBSTANTIATED REMARKS MADE BY
HEALTHCARE PROVIDERS ON TREATMENT AND MEDICAL CARE GIVEN BY OTHER
PHYSICIAN
• PERCEIVED ARROGANCE, ALOOFNESS AND UNCARING ATTITUDE BY HEALTHCARE
PROVIDER
• NEGATIVE PERCEPTION BY THE PUBLIC ON THE MEDICAL COMMUNITY BROUGHT ABOUT
BY THE BAD PUBLICITY AND SENSATIONAL TREATMENT BY THE MEDIA ON ALLEGED
NEGLIGENCE CASES
• POOR RECORD KEEPING WITH REGARDS TO THE MEDICAL RECORDS OF THE PATIENT
• PERCEPTION THAT THE PHYSICIANS ARE GENERALLY NOT COMFORTABLE WITH LAWSUITS,
COURT PROCESSES AND NEGATIVE MEDIA EXPOSURE AND ARE THUS MORE AMENABLE TO
MONETARY SETTLEMENTS WHEN SUED
• COMMERCIALIZATION OF MEDICAL PRACTICE
• PATIENTS ARE NOW MORE AWARE OF THEIR RIGHTS, MORE PROACTIVE AND MORE
KNOWLEDGEABLE ON MEDICAL MATTERS BECAUSE OF THEIR ACCESS TO THE INTERNET
AND OTHER MEDIA OUTLETS
• BAD OUTCOMES OF TREATMENT DUE TO PERCEIVED INCOMPETENCE OF THE PHYSICIAN
 16. WHAT SHOULD BE
CONSIDERED IN DETERMINING
A PROFESSIONAL FEE?
 PMA CODE OF ETHICS OF THE MEDICAL
PROFESSION
• ARTICLE II – DUTIES TO PATIENTS
• SECTION 6. THE PHYSICIAN SHOULD BE FAIR AND CONSIDERATE IN DETERMINING HIS
PROFESSIONAL FEE, TAKING INTO ACCOUNT THE COMPLEXITY OF THE CASE, THE
DURATION OF CARE, HIS EXPERTISE, CURRENT FEES AND THE ECONOMIC STATUS
OF THE PATIENT.
 17. SHOULD A PHYSICIAN
ALWAYS TELL A PATIENT THE
TRUTH ABOUT THE LATTER’S
CONDITION?
• THE PHYSICIAN KEEPS THE INFORMATION IN GOOD FAITH AND MUST TELL IT TO
THE PATIENT AS THE LATTER NEEDS/WANTS IT.
18. WHAT IF THE TRUTH IS
UNPLEASANT AND WILL
“HARM” THE PATIENT?
• PATIENT’S BEST INTEREST
19. WHAT ARE SOME REASONS FOR
NOT TELLING THE TRUTH ABOUT
THE PATIENT’S CONDITION
ESPECIALLY IF IT IS BAD NEWS?
• THE TRUTH (DIAGNOSIS) IS UNCERTAIN
• FILIPINO CULTURE
• TELLING IS PERCEIVED TO BE USELESS
• TELLING IS HARMFUL
• TELLING TAKES TIME AND THE DOCTOR DOES NOT HAVE THE LUXURY OF TIME
• THE DOCTOR CHOOSES NOT TO TELL THE TRUTH BECAUSE HE/SHE IS NOT
CONFIDENT OF HOW TO DO IT
 20. WHO SHOULD DISCLOSE
THE TRUTH TO THE PATIENT?
 SHOULD A PATIENT BE TOLD
OF “ACCIDENTS” THAT MAY
OR MAY HAVE HURT HIM/HER?
• “A 2 YEAR OLD CHILD WAS REFERRED TO MAJOR MEDICAL CENTER WITH A
SWELLING WHICH THE SURGEON THOUGHT WAS A TUMOR SINCE THE BIOPSY
WAS READ AS BEING A TUMOR. THE CHILD HAD NO TUMOR. THE SURGEON
OPERATED, EXPECTING TO REMOVE A PORTION OF THE MUSCLE FROM THE
VICTIM’S BACK. IN SURGERY, HE DISCOVERED THAT THE LESION WAS MUCH
MORE EXTENSIVE THAN HE HAD THOUGHT BEFORE SURGERY. HE SHOULD HAVE
KNOWN THAT TUMORS DON NOT GROW SO RAPIDLY AS TO HAVE RESULTED IN AS
EXTENSIVE AN INVOLVEMENT AS WAS PRESENT. HE DIDN’T, AND IN ORDER TO
GET ALL THE GROSS TUMOR HE AMPUTATED HER ENTIRE SHOULDER AND RIGHT
ARM. THIS EXTENSIVE SURGERY FURTHER AGGRAVATED THE CONDITION, WHICH
SHE DID IN FACT HAVE”
 21. IS IT ALWAYS NECESSARY TO
OBTAIN THE FREE AND INFORMED
CONSENT OF A PATIENT? WHY IS IT
IMPORTANT?
• “EVERY PERSON IS THE OWNER AND MASTER OF HIS OWN BODY. HE DECIDES
WHAT IS GOOD AND WHAT IS BAD FOR HIS OWN MATERIAL BODY. HE HAS THE
ABSOLUTE RIGHT TO DECIDE WHAT AND WHAT NOT TO DO WITH HIS OWN BODY”
• SUFFICIENCY OF THE QUANTITY OF INFORMATION
• SUFFICIENCY OF COMPREHENSION OR UNDERSTANDING
• VOLUNTARINESS IN GIVING THE CONSENT
 INFORMED CONSENT IS VITAL BECAUSE

• IT DISPLAYS REGARD FOR THE WORTH OF A PERSON INCLUDING THE CONSENT

TAKER
• IT SUPPORTS THE DUTY OF A PERSON TO UPHOLD HIS/HER PERSONAL
RESPONSIBILITY
• IT PROTECTS A PERSON’S PERSONAL INTEGRITY – AVOIDING ABUSE, FRAUD AND
DURESS
• IT PROMOTES COOPERATION AND BETTER OUTCOMES
• IT ENCOURAGES SELF-SCRUTINY BY THE CLINICIAN/RESEARCHER
• IT REDUCES COMPLAINTS, AND PREVENTS CIVIL AND CRIMINAL LIABILITY OF
ASSAULT, OR INTRUSION OF PRIVACY
 22. WHEN CAN FREE AND
INFORMED CONSENT BE NOT
OBTAINED?
• DURING EXTREME EMERGENCY SITUATIONS WHEN THERE IS IMMEDIATE THREAT
TO THE PATIENT’S LIFE, OR WHEN OBTAINING THE CONSENT WILL RESULT IN AN
IRREVERSIBLE INJURY TO THE PATIENT
• WHEN THE PATIENT IS UNCONSCIOUS AND OBTAINING A CONSENT WILL RENDER
ANY IMMEDIATE MEDICAL OR SURGICAL PROCEDURE USELESS
• WHEN THE LAW REQUIRES A MEDICAL OR SURGICAL PROCEDURE TO BE DONE
 23. WHAT ARE SOME COMMON
PROBLEMS ENCOUNTERED WHEN
OBTAINING FREE AND INFORMED
CONSENT?
• DECIDING HOW MUCH INFORMATION TO GIVE
• ASSESSING FREEDOM AND VOLUNTARINESS
• HAVING PATIENTS WHO SIMPLY LEAVE THE DECISION TO THE DOCTOR
• HAVING DISAGREEMENT BETWEEN OR AMONG FAMILY MEMBERS
 24. IS A COMPETENT PERSON’S (PATIENT
OR SURROGATE) DECISION ALWAYS TO BE
ACCEPTED? WHAT ARE THE APPROPRIATE
AND INAPPROPRIATE DECISIONS?
 HIERARCHY OF GIVING INFORMED CONSENT

• PATIENT
• SPOUSE
• ELDEST CHILD
• PARENTS OF THE PATIENT
• GRANDPARENTS OF THE PATIENT
• BROTHER OR SISTER OF THE PATIENT
• NEAREST KIN AVAILABLE
• STATE
25. WHAT DO THE RIGHT TO
PRIVACY AND THE RIGHT TO
CONFIDENTIALITY MEAN?
 Right to Privacy Right to Confidentiality
A person has the right to keep personal information A healthcare professional does not disclose to others
secret his/her patient’s personal/private information
Question no. 26
Is confidentiality
in health care
absolute??
 NO, confidentiality can be breached.
 For example, when patients give consent to disclose private
information so that others can empathize with them,
confidentiality is not breached.
 Another is that it can be overridden to prevent greater harm.
 Ex: a suicidal patient. Parents of such patients must be
informed so that measures can be implemented to protect
the said patient.
 If it’s in the best interest of the public.
Question no. 27

Is telling the spouse of a

patient that his or her
wife/husband has STD to
prevent transmission of a
disease a breach of
confidentiality?
 According to the book, if the spouse is not our patient, then our obligation to our
patient ( the one infected) is greater. The spouse need not be told.
 However, if the spouse is in general danger. Like for example they are a sexually
active couple, then we need to tell the spouse. But if our patient is not in contact
with the spouse ( eg. Ofw who got the disease abroad) then we need not tell the
spouse.
 We should also consider the gravity of the disease.
Ex. Gonorrhea
AIDS
We should also weigh the benefit that can be derived from telling. If we think that
the benefit outweighs the risk of breaking confidentiality, then we should tell.
Breaching confidentiality is justified to protect the health and well being of a
person
 28


What are some common breaches
of confidentiality in everyday
hospital life?
 1. Health care providers talking about their patients in
elevators, corridors and cafeterias.
 2. Easily accessible patient’s name, medical charts and
laboratory results
 3. Public hospitals with crowded wards and common areas
which do not offer any privacy
 29

When does life begin?

Life begins at fertilization.
 31

Why is abortion morally wrong?

Why do some hospitals refuse to
accept patients who have had an
abortion?
 Abortion is morally wrong because it is killing an innocent human being
through directly intended termination of pregnancy before the age of
viability. Life is sacred and must be protected from the moment of
conception.

 Some hospitals refuse to admit patients who have had an induced abortion
because of the risk of rendering material cooperation to an immoral act and
the danger of scandal for a Catholic healthcare institution perceived to be
allowing abortion.
 32

Should aborted fetuses be used for

learning or research?
 Only spontaneously aborted fetuses should be used for learning or research
with the consent from both parents and provided that proper respect is given
to the fetus.
 Fetuses from induced abortions should not be used for learning or research
because of the danger of justifying or making it appear less evil.
 33

May contraceptives be given to a

victim of sexual assault?
 Directive 36 of the revised Ethical and Religious directives for Catholic Health
Care Services states that:
 “ A female who has been raped should be able to defend herself against a
potential conception from the sexual assault. If after testing, there is no
evidence that conception has occurred already, she may be treated with
medicines that prevent ovulation, sperm capacitation or fertilization. It is not
permitted however, to initiate or recommend treatments that have as their
purpose or direct effect the removal, destruction or interference with
implantation of a fertilized ovum.”
 34

When is sterilization allowed?

 Sterilization ( removal or disabling) of a healthy functioning organ leads to
physical, emotional and spiritual harm. Direct sterilization is not allowed.
 Procedures that may result in sterilization may be permitted provided that:
 1. they are immediately directed to the cure and alleviation of a present and
serious pathologic condition.
 2. They are not intended to be directly contraceptive
 3. An alternative non sterilizing treatment is not reasonably unavailable
 35

Which assisted reproductive

techniques are considered ethical?
 Promotion of pregnancy through methods which enhance reproduction such as
hormones to correct defect in women are ethical.
 Reproductive technology which replaces the conjugal act or the natural
gestational process with laboratory procedures is unethical. It includes
heterologous and homologous artificial fertilization, in vitro fertilization and
embryo transfer and surrogate motherhood. This processes allow the power of
technology to invalidate the sacredness of life.
 “Compassion for the infertile does not justify unethical conduct.”
 36

How should one deal with maternal-

fetal conflicts? How does one choose
between the mother and the baby?
 The fetus enjoys the same right to life and dignity as the mother and the mother’s
interest should not be preferred over those of the fetus.
 Maternal fetal conflicts are complications occurring during pregnancy which require
therapeutic and diagnostic interventions that may adversely affect the fetus. These
interventions are permitted until the unborn child is safely viable and can be
delivered. In such situations, the principle of double effect is followed:
 1. intervention is directly intended to cure or benefit the mother
 2. it is not a direct attack on the fetus
 3. there is a proportionately serious pathologic condition which requires immediate
treatment
 4. there is no alternative
 5. the good effect precedes or is simultaneous with the bad effect
 37

Why is cesarean section by request not

allowed?
 CS by request is not allowed because it carries inherent anesthetic and
surgical risks and maternal and fetal morbidity. It violates the principle of Non
maleficence and is not of the patients best interest.
 38

How should one deal with an

anencephalic fetus?
 Anencephalic fetuses should reach term, be baptized at birth (if catholic)
room in with the mother and die in the parent’s arms. Ordinary care should
be provided until the baby dies. Donating the organs of the infant is
encouraged provided that there is parental consent.
 The early delivery of an anencephalic fetus is sometimes regarded as helping
the parents avoid the psychological suffering of carrying such a child. It is also
said to allow a new pregnancy to occur. These reasons are unacceptable. The
impairment of an anencephalic infant is not a justification for early delivery
before viability. It hastens the death of the infant.
 39

Why the fuss about the fetus?

 Because the fetus belong to the vulnerable population, cannot express
his/her wishes and cannot give consent , cannot defend itself and must be
protected against being killed or put at a disproportionate risk
 40

Are doctors who do not perform

abortion, sterilization or IVF allowed
to refer the patient requesting for any
of those procedures to another
institution or doctor where it is
performed?
 No, abortion, sterilization and IVF are all ethically
unacceptable. Referring is cooperation in what is ethically
unacceptable and it is therefore a wrong doing.
 41

What about PGD?

Book’s answer

PGD is permitted if it brings minimal harm and if it is used to screen embryos for
disease traits to prepare parents to care for their child and not to abort
defective ones.
In addition, justice is violated because of its cost. PGD is only available to the
wealthy and government funds to provide the poor cannot be justified because
these limited resources should be allocated to more urgent high impact public
health program
 42

What should one consider about

genetic engineering/ gene therapy?
 The ethical considerations in this domain should include the ff:
 1. Motive- it should be for the good of the person or society
 2. Means- There should be enough scientific evidence to ensure safety
 3. Respect for person- embryo cannot be used merely as a means, altered to
become a baby that the parents like. Remember that the baby cannot give
consent
 4. Justice- It should be available and affordable to all
 5. Stewardship- it should not violate the right of every individual to an intact
genetic heritage.
 6. Slippery slope- human beings should not slide down the slope from
legitimate enhancement to illegitimate tampering or eugenic breeding.
 43

Why are children special?

 Ethical issues such as treatment withdrawal, privacy and free and informed
consent take on a different view when children are involved because they are
easily harmed, vulnerable and should be protected.
 In giving free and informed consent, the child is often not competent to
decide, is seldom free from outside forces and may be unable to
communicate his/her wishes to or defend his/her choice
 44

Should children be told the truth?

 Children who have the capacity to understand, their parents and guardian
have the right to and should tell the whole truth even if the diagnosis
indicates a terminal illness.
 45

Isinformed consent required for

procedures on children?
 Yes, free and informed consent is required for all medical procedures and
treatments except in an emergency and the child is left alone in the hospital
and consent cannot be obtained.
 Child’s parent who have the right and duty to make decisions for their child,
give consent. In case the decision of the consent giver is appears to be against
the best interest of the child, the pediatrician should discuss the matter with
the consent giver. In the absence of a family designated guardian, the
hospital director or his/her appointee acts as guardian.
 The child should be involved in the decision to the extent of his/her ability to
understand and decide for himself.
 46

Do children have the rights to privacy

and confidentiality?
 Yes, children have rights to privacy and confidentiality but parents and
guardians who make the decisions for and support the child have to know the
truth about the condition of the child. However as long as no harm to other
people is at stake, others need not be told.
 47

How does one deal with a female

adolescent who refuses to have her
parents told she is taking the pill or
has STD?
 Adolescents are often reluctant to talk to their parents about sexual matters. They choose
to seek advice from doctors. Without the assurance of confidentiality, they may choose not
to seek help at all, and this decision risks exposure to unwanted pregnancy and sexually
transmitted diseases.
 When a female adolescent refuses to tell her parents that she is taking the pill or has STD,
the physician should explain to her that family support is vital and parents should be told.
The physician can help tell the parents about her condition.
 If she still refuses, the doctor should try to determine her maturity. Can she be treated as
a responsible agent to understand the information provided and to perceive and live with
the consequences of her decisions?
 If she is mature, this could convince the doctor to consider ethical gain in maintaining
confidentiality to outweigh the apparent encroachment of the parents right to know and
decide for their children.
 If she is not mature enough, then the doctor should override her wishes and tell the
parents.
 48

When is withholding care

allowed for a neonate?
 Witholding life sustaining care may be allowed in the following circumstances:
 1. For newborns who would certainly die regardless of any medical treatment
or for those newborns who would survive but with intensive treatment and
that the prognosis for later life is poor.
 2. For neonates who even if survival is achieved are likely to experience
severe disabilities, pain and suffering, poor quality of life and high cost of
care.
 When life sustaining care is withdrawn, neonates should continue to be kept
warm, nourished and treated with dignity and love.
 49

May children be used as learning

and research subjects?
 Children may be used as research subjects under the ff circumstances:
 1. The research is likely to directly benefit the child.
 2. The research will probably cause only minimal unavoidable harm and is
proportionate to the benefit
 3. the parents or guardian give consent and the child agrees to be a research
subject
7-12 = verbal assessment
12-15 = simplified assent form approved by bioethics committee
15 years and above = same informed consent form as that of the

parents
 50

Can the child be an organ donor?

 A child can only be an organ donor if deceased.
 Under extremely rare conditions however, a child may donate an organ to a
sibling who is loved by the child provided no other donor is available, the
child donor understands what the donation means and gives assent to it, and
the donation is approved by the bioethics committee.
 51. Why is ghost surgery
unethical?

• Ghost surgery occurs when the patient is not informed of,

or is misled, as to the one who will perform the surgery
 Ghost surgery is unethical
• Violates the patient’s right to choose his/her surgeon
(Principle of Autonomy) and full disclosure.
• Added injustices
– Surgeon is unable to lend his/her expertise in the post-
operative care
– The patient is made to pay the surgical fee of both the
attending and the operating surgeons
 UNESCO
Universal Declaration on Bioethics and
Human Rights
Article 5- Autonomy and individual responsibility
“The autonomy of persons to make decisions, while taking
responsibility for those decisions and respecting the
autonomy of others, it is to be respected.”
 52. Is incidental surgery ethical?

• Incidental surgery occurs when a part of the body is

removed as an unintended additional procedure to the
intended operation
 Incidental surgery is allowed when the following
requirements are met:
1. The part removed is a present or future danger to the
patient
2. The added procedure present no significant danger to
the patient or the expected benefit the patient will get
from the surgery outweighs the added risk
3. Informed consent is given by the patient or his/her
proxy/representative.
• Principle of autonomy “informed consent”
• UNESCO Article 6, “Any preventive, diagnostic and therapeutic
medical intervention is only to be carried out with the prior, free and informed
consent of the person concerned, based on adequate information. The
consent should, where appropriate, be express and may be withdrawn by the
person concerned at any time and for any reason without disadvantage or
prejudice”
• Principle of Beneficience
• UNESCO Article 4 – Benefit and harm
“…direct and indirect benefits to patients, affected
individuals should be maximized and any possible harm
to such individuals should be minimized”.
 HIPPOCRATIC OATH
• “the health of my patient will be my first consideration”
code of ethics Philippine Medical Association Article II
Section 1
“A physician should be dedicated to provide competent
medical care with full professional skill”
 The Terminally Ill
53.Who are terminally ill?

-incurable sickness- cause death within 6 months

-dying
• 54. Should a terminally ill patient be told
that he/ she is dying?
 In general
YES
Philippine Medical Association Article II Section 5
“A physician should exercise good faith and honesty in expressing opinion/s as
to the diagnosis, prognosis, and treatment of a case under his/her care…Timely
notice of the worsening of the disease should be given to the patient and/or
family. A physician shall not conceal nor exaggerate the patient’s condition
except when it is to the latter’s best interest”.
55. Which measures (diagnostic or therapeutic) should a
doctor recommend/not recommend when caring for
someone who is terminally ill?
• A doctor must be trustworthy
• A doctor should ask “What will the specific measure do
for this patient to achieve the spiritual purpose of his/her
life?”
– The value of life relates to present or future capacities such as having self-
consciousness, ability to establish a relationship with other human beings and God, and
the ability to derive some pleasure from existence.
• A doctor should NOT recommend any measure which
according to his/her competent judgement will not do
good or likely to do harm than good
– Physically deteriorate
– Financially poor
– Spiritual pain
– Discomfort or suffering without a proportionately greater good.
• A futile measure does not do good for the patient as a
whole- serves no useful purpose
– If a measure does not make the patient’s life better or if it only
prolongs suffering, then it is FUTILE
– They prolong suffering, delay peaceful death (dysthanasia),
waste resources and violate the integrity of the health provider.
– In caring for the dying, limits must be set
• The doctor should also ask, “ What will giving this specific
measure and prolonging life mean to the patient and to
the people who must care for him/her?
• Would the burden be in accord with the common sense of
the Christian community?
• Would the patient and family be willing to accept this
burden?
– Unjustifiable burden is another reason to prevent
recommending a particular measure.
• The doctor should expend all reasonable efforts to clearly
and accurately explain to the patient and his/her family
– Benefits
– Harms
– Limits
– Consequences
* It is the doctor’s responsibility to recognize when a measure is
beneficial, harmful or futile using his/her scientific expertise.
• 56. Which measure (diagnostic or therapeutic) should a
terminally ill patient/representative accept or refuse?
• It is the patient’s right to control his/her own life and
decide what to accept and what to refuse.
• In GENERAL:
– a measure likely to cure the patient or benefit him/her should be
ACCEPTED
– A measure which is harmful or futile should be REFUSED.
 Based on proportionality:
• Proportionate measure
– More of benefit than a burden
– acceptable
– Ordinary, obligatory

• Disproportionate measure
– may be refused
– Burden outweighs its benefit, too expensive, too painful, too
emotionally difficult
– Extraordinary, or optional

*Even if a measure may help, it may still be disproportionate and

refused by the patient.
• 57. Who decides if the measure is to be given or not?
• A competent patient decides
– Respect for person means respect for his/her life
–Not competent
• He/she should still be involved in the decision to the extent he/she is able
• Child- simple information and choices
• Unconscious adult- left and advance directive for preferences
• Without advance directive- a family member who know the patient well
• Surrogate or substitute- analysis of the patient’s previous expression of
choices; may be based on the patients best interest.
• 58. Should a doctor always keep the patient alive as long
as possible, no matter how dim the prognosis? What if
death is inevitable (probably within the next few days) and
only postponable? When and for how long should death
be postponed?
 In GENERAL
• A doctor should keep the patient alive.
• However,
– No hope of improvement , keeping him/her alive, only prolongs
suffering, is harmful, and should not be done
– DYSTHANASIA
 Situations when a dying or terminally ill may be kept
alive for good reason
With patient’s consent and when possible. With the family’s agreement

• Wait for a loved one to come home, to make peace, ask

forgiveness, or to say good-bye
• To give ample time to accept the inevitability of death for as long as
the patient is not suffering
• Potential organ donor
• Proper decision making- for family disagreement

In doubt- a doctor should consult with the patient’s family, get a second opinion or refer the case to the
bioethics committee.
• 59. Can treatment sometimes be wrong because it is
inhumane?
• Subjecting a person to unnecessary suffering or violating
a person’s dignity is inhumane and wrong
• Manner of death- never be humiliating
• Surgical procedures for moribund patients- refused
 60. Is “allowing to die” the same as “killing”?
• No
• “allowing to die”- doing nothing
• “killing”- doing something
 61. Is forcing life-saving treatment suicide or
euthanasia (mercy killing)?”
• Pope John Paul II (1995)
– “To forgo disproportionate means is not the equivalent of
suicide or euthansia; ot is rather expresses acceptance of the
human condition in the face of death.”
– Forgoing life-saving treatment- no intention to kill
– Suicide and euthanasia have
 62. Is there an ethical difference between withholding and
withdrawing life-prolonging treatment
• NO
-underlying principle-refusal of life-prolonging
treatment
-Whether it has not started and, therefore, withheld, or has
started , stopped, and therefore, withdrawn is the same.
 63. When the patient, family, and healhcase providers agree that
death is eminent, is any treatment always morally required?

• YES
– Basic need should be attended
• Respect
• Right not to be harmed
– Basic needs:
»Nursing case
»Phsysiological care (food and fluid/water )
»Spiritual care
*these are morally obligatory and should be continued until death ensues
 64. Can Analgesia and sedation be administered
even if then hasten death?
• YES
– Principle of double effect
• Relieve pain and discomfort and not to cause death
• Relief of pain and discomfort is greater value to a dying patient than not
hastening death.
• Article 3 – Human dignity and human rights

1. Human dignity, human rights and fundamental

freedoms are to be fully respected.
 65. Should every kind of suffering/pain be given
medical relief?
• NO
– Some patients refuse
 66. What are the doctor’s responsibilities when
caring for the terminally ill?
• 1. Competence- recognize and apply proper measure
• 2. Compassion- refuse to cause additional suffering
• 3. Provide a “good death” (orthothanasia)- relieve the
patient’s pain and suffering
 The Physician as a Medical Professional
• The Physician-physician relationship
67. How should a physician behave on referrals?
• Good judgement, appropriate communication, appropriate
communication, honesty and goodwill underlie the referral
process.
 1. Medical Referral
• A. should explain to the patient/proxy the reason for the
referral, expected outcomes (benefits and burdens), and the
name of the proposed or recommended consultant.
– Both should agree to the referral.
B. The attending physician orders the referral and informs the
consultant specifying the purpose of the referral.
C. Once a consultant accepts, he/she should see the patient as soon
as possible
-referral for evaluation- attending physician
-referral for co-management- consultant
• D. If upon receiving the referral and the consultant can no
longer wishes to attend to the patient, the consultant should
notify the attending physician for appropriate action.
• E. Consultants should not make cross referrals but may
suggest to the attending physician.
• F. After the condition for which the patient was originally
referred has been resolved, the consultant should submit a
separate professional fee billing and end his/her services.
– Follow up- original attending physician unless are delegated
 2. Surgical release
• A. intraoperative referral to a consultant is appropriate
• B. if circumstances do permit patient, or his/her next of kin
should be informed of the need for the intraoperative
referral; and consent prior making the referral
• C. if circumstances do not permit, introduced to the
consultant surgeon as soon as possible.
• D. the consultant surgeon should provide the intra-
operative, post-operative and follow-up care
 68. How should a physician behave regarding a
conflicts in care?
• As a rule:
– The first physician called is the primary attending physician who
should coordinate the care given.
– If physician disagree on what should be done, they should first
talk and listen to one another
– If still there is no agreement, then it is the duty of the primary
attending physician to explain the predicament to the patient as
well as the benefits and burdens of alternative actions and to let
the patient decide.
69. Should a physician charge another physician for his/her
professional services? What about another physician’s
relatives
• NO
• -another physician
• -immediate dependent relatives (spouse, minor children,
parents and siblings)
 70. What should a physician do about an incompetent
/unethical (erring) colleague?

• An incompetent or unethical physician harms patients and the profession

and should not be allowed to continue practicing
incompetently/unethically.
• A Physician should first try to help his/her colleague with guidance and
teaching.
• If persists, should inform his/her colleague's immediate supervisor or
head.
• if still appear incompetent or unethical, he/she should inform the hospital
director or municipal
• Philippine Medical Association and the professional regulation
commision
 International code of ethics (1949; 1983)
• “Shall strive to expose those physician deficient in
character or competence or who engaged in fraud and
deceptions”
 Philippine Medical Association
code of ethics
• Article IV Section 9
• “A physician should encouraged to the Philippine Medical
Association or the Board of Medicine personal knowledge
pf any corrupt or dishonest conduct of the members of the
profession”
 71. should the training officer of a residency or
fellowship program also be attending physician of
his/her trainee??
• No. being the attending physician of one’s own trainee
would result in a conflict of interests. As the training
officer, the development of competence and character of
the trainee is his /her priority; as the attending physician.
Health is his/her priority. This may affect his/her decisions
such as letting the trainee be exposed to patients with
infectious diseases or allowing the trainee to file an
extended sick leave
 72. What is the nature of the physician-other
healthcare professional relationship?
• All health care providers, physician, therapist, and
pharmacist among others share the same commitment to
care for the sick and promote health.
 73. How does one constructively criticize another
team member who made a mistake?
• Constructive criticism involves speaking truthfully and
sincerely.
• The two should then analyse why it happened and
discuss how to prevent it from happening again.
• Whenever possible, the team member himself/herself
who made the mistake should be empowered to correct
the damage done and to implementing measures o
prevent it from happening again.
 74. What is the nature of the physician
pharmaceutical company relationship?

• The physician- pharmaceutical company relationship

should be one of cooperation and mutual respect aimed
and providing the best patient care.
 75. What is drug promotion, and how do they work?

• Drug promotion involves all information and activities

provided by the industry to the practitioner to induce
prescription, purchase, or use of medicinal drugs.
• These sales marketing strategies include literature,
advertising, gifts, hospitality, continuing medical
education, research, and physician endorsements.
76.) WHAT CAN COME FROM
DRUG PROMOTIONS?
 Patients Health
Professionals
• Wrong information • Bias when it comes to
• Self-medication prescribing

3 Bad Outcomes of Drug Promotion

 Patients receive less than the best health care

 Character is eroded
 There is loss of respect for self and others
 LOSS OF RESPECT
CHARACTER
IS ERODED FOR SELF AND
OTHERS
Drug
Physician Representative Research clearly shows that
• Dependent • Unethical doctors who report relying more
• Self-interested • Bribes
• Irresponsible • Uses doctor as
on promotion tend to prescribe
• Deceptive advertising less appropriately, prescribe more
billboard often and adopt new drugs more
quickly.
PATIENTS RECEIVE LESS THAN
THE BEST HEALTH CARE

NON- THERAPEUTIC INTERFERENCE WITH INCREASED DRUG COST

BASIS FOR SERVICE
THERAPEUTICS
-out of town trip
-utang na loob Which results to absences
-pakikisama from clinic
77.) HOW CAN A PHYSICIAN
BEHAVE ETHICALLY IN
RELATION TO
PROMOTIONS
 Should know that accepting of
gifts affect clinical judgement
 Should write prescriptions based
on rational drug use principle
 Should behave honorably with
transparency and courage. A
physician should be trustworthy,
responsible and have self respect
78.) WHAT IS THE ROLE OF
CATHOLIC PHYSICIAN IN THE
MIDST OF POVERTY?
CATHOLIC PHYSICIAN
 career or occupation
 It is truly a vocation—a response to a divine call to manifest God’s
love for others through fulfilling the obligations of a medical life.
 This in turn requires living a personal life consistent with Gospel
teaching and incorporating that teaching in the personal care for the
patient and the moral choices that are integral to that care.
BISHOP JOHN FISHER
3 Obligations of a catholic physician
Provide free cares
Share one’s assets
Work towards healthcare policies that help the poor
79.) HOW DOES ONE
ALLOCATE JUSTLY A
SCARCE RESOURCE SUCH
AS AN ICU BED OR A
DONATED ORGAN?
 Philippines is in need of 45,000
additional hospital beds and more
public health physicians to provide
medical services to 105 million
Filipinos across the country

-scientific criteria
-choose who can most be helped
(TRIAGE)
TRIAGE ICU
First Second group Third group
group
First-come First-
-will only -may benefit -the resource
benefit but will likely will have served basis
minimally survive greatest
Terminally ill without the impact
-are likely to resource PRIORITY
die even with -mildly ill/ GROUP
Lottery system
resource self-limited
illness
Senate Bill (the Organic Act of 2018) introduced by Sen.
Richard J. Gordon seeks to provide an “Opt-Out System
of Organ and Transplantation, amending Republic Act
7170 otherwise known as the Organ Donation Act of
1991.”

ORGAN
DONATION
 A person who has not registered any objection at any
given time with the DOH-PhilNOS in respect of any
organ shall be prioritized
 a person who has registered his objection with the
DOH-PhilNOS, in respect of any organ, but who has
withdrawn such objection shall have priority over a
person who has registered such objection
 a person who has registered his objection with the
DOH-PhilNOS shall be given least priority.
80.) HOW
SHOULD A
PATIENT WHO
NEEDS HEALTH
CARE BUT HAS
NO MONEY TO
PAY BE
TREATED?
 Respect for 81.) WHAT ETHICAL
human life CONSIDERATIONS ARE
 Human INVOLVED WHEN DEALING
Dignity WITH STEM CELL THERAPY?
 Stem cell treatment is a type of
intervention strategy that introduces
new adult stem cells into damaged
tissue in order to treat disease or injury,
including cancer and HIV as being
alleged in news reports.
 The DOH strongly advised the public
to avoid stem cell therapies, which use
the following as sources for stem cells:
embryonic stem cells, aborted fetuses,
genetically-altered and animal fresh
cells.
82.) WHY IS PAYING
AN ORGAN DONOR
UNETHICAL?

 Human organ is not a

commodity
 Violates human dignity
 It should be an act of
generosity
  It is the right thing to do
 Past unethical/moral dilemmas
83.) WHY IS  Protection of vulnerable = human and
animal
ETHICS  Protection of human rights
NEEDED IN  It preserves credibility/ trust
RESEARCH?  It transforms ”empty” harmful,
worthless research to a useful, helpful
one
84.) WHO IS RESPONSIBLE
FOR ETHICS IN RESEARCH?
 International Bodies
 FDA
 Philippine Health Research Ethics Boards
 Professional societies
 National committee on biosafety (NCB)
 Department of Science and Technology (DOST)
 Department of Health
 Department of Education
 Commission on Higher Education
WHO-Standards and operational guidance for ethics
review of health-related research with human 85.) WHAT
participants
ARE SOME
International ethical guidelines for epidemiological USEFUL
studies 2016
POPULAR
INTERNATIO
World Medical Association: Declaration of Helsinki
NAL
GUIDELINES
European Group on Ethics FOR ETHICS
IN
International ethical guidelines for biomedical research RESEARCH?
involving human subjects
PHREB (Philippine Health Research Ethics Board)
launches 2017 National Ethical Guidelines for Health
and Health-Related Research
86.) WHAT
ARE SOME
In 1984, the Philippine Council for Health Research
and Development under the Department of Science
NATIONAL
and Technology (DOST) created the National Ethics
Committee (NEC) EFFORTS
FOR
established the Philippine National Health
Research System (PNHRS) ETHICS IN
RESEARC
DOST AO No. 001 series of 2008, “Requiring of
all Ethics Committees at Philippines Health
H?
Research Ethics Board (PHREB)
87.) WHAT IS Independent body specially appointed to
address the ethical dimension of research
THE
INSTITUTIONA MAIN FUNCTION
 Ensure scientific merit and ethical soundness of
L ETHICS research
REVIEW  Evaluate and approve protocols
 Ensure qualified researcher
COMMITTEE  Ensure proper documentation
(IERC) AND  Archiving proposals ,actions and reports

WHAT IS IT’S  Support the researcher

 Establish SOPs
RESPONSIBILIT  Regulate funds

IES?
 88.) WHAT Truthfulness and
IS confidentiality
UNDERLYIN Autonomy and informed
G consent
PRINCIPLES Beneficence

OF ETHICS Nonmaleficence
RESEARCH? Justice
89.) HOW MUCH AND WHAT KIND OF HARM
IS ALLOWED IN RESEARCH? HOW ARE
PARTICIPANTS PROTECTED FROM HARM?
Psychological Harm
Physical Harm
Legal Harm
Social Harm
Economic Harm
90.) WHY IS RESEARCH
PURELY FOR KNOWLEDGE’S
SAKE NOT CONSIDERED
ACCEPTABLE?

Humans are the subjects

91.) IS THE FREE AND
INFORMED CONSENT GIVEN
BY RESEARCH PARTICIPANTS
THE SAME AS THAT GIVEN
BY PATIENTS FOR
TREATMENT?
 It is essentially the same
 92.) IS
INFORMED  The purpose of the study

CONSENT  Expected duration

 Procedures of the study
NEEDED  Information on their right to decline or
FROM ALL withdraw
PARTICIPAN  Foreseeable consequences of withdrawing
or declining
TS IN ALL  Potential risk, discomfort or adverse effects
RESEARCH  Prospective research benefits

STUDIES?  Incentives, such as payment or rewards

 Whom to contact for questions
 Truthfulness and confidentiality

93.) IS Autonomy and informed consent

OBTAINING FREE
AND INFORMED
CONSENT Beneficence
SUFFICIENT TO
MAKE A
RESEARCH
STUDY ETHICAL?
Nonmaleficence

Justice
94.) HOW DOES JUSTICE OR THE CONCEPT
OF “EQUALITY TO OTHERS” MANIFEST IN
RESEARCH?

 There should be no discrimination in the selection

 Every member of the population who may benefit should
have equal chance
 Developed and developing countries should have the same
standards
95.) WHO ARE THE “VULNERABLE
POPULATIONS”? WHY DO THEY NEED
SPECIAL PROTECTION?
Vulnerable
Special Classes
Populations
children students

prisoners employees

Pregnant women cognitively impaired

individuals
96.) HOW MUCH REMUNERATION SHOULD BE
GIVEN TO RESEARCH PARTICIPANTS? WHAT IS
CONSIDERED AN ”UNDUE INFLUENCE”?
Remuneration- a way to pay
participants for there effort and
service

Undue Influence- often occurs

through an offer of an excessive
or inappropriate reward
97.) WHY SHOULD THE ATTENDING
PHYSICIAN NOT BE THE RESEARCHER
AT THE SAME TIME?
Attending Physician Researcher
Prescribes the best Has doubts about the
medicine benefits
Will not give the medicine Not test a drug that he/she
that he/she doubts to be the knows the best
best
Order specific test that will Orders lots of test
benefit the patient
 98.) WHO SHOULD BE LISTED
AS AUTHORS IN A
RESEARCH?
AUTHOR
 Contributed substantially to
 Lead author conception and design,
 Co-author
acquisition of data, or analysis
and interpretation of data
 institute
 Provided final approval
 Drafted the article or revised it
 Agreed to be accountable for all
aspects of the work
99.) WHY IS PEER
REVIEW
ESSENTIAL IN
RESEARCH?

 To have positive
criticism
 to improve your
research
 To validate your
research
100.) WHAT ARE SOME
OTHER UNETHICAL
PRACTICE TODAY?
 Plagiarism
 Paying health care providers like doctors to
manipulate the result of their research
 Using doctors name and license to conduct
research without the physicians guide
 Manipulating result to acquire positive
results