BIOETHICS FINALS WK5 Flashcards
◦Withdrawal of the penis before Ejaculation
CONTRACEPTION
◦Abstinence
CONTRACEPTION
◦Intrauterine devices (IUDs)
CONTRACEPTION
◦oral contraceptives (birth control pills), subdermal implants
of synthetic progestin, transdermal patches
◦Emergency contraception: hormonal: levonorgestrel
pill
◦Hormonal: CONTRACEPTION
tubal ligation and vasectomy
◦Surgical sterilization:
◦Cancer cells, sperm, and ova all have a human genetic
code, and on the least restrictive definition of genetic
humanity, such cells would have a _________, implying that
if abortion is impermissible, then so is contraception and
chemotherapy
right to life,
patients possess rights to
contraceptive treatment to reduce
unplanned pregnancy and their resort
to abortion
UTILITARIAN view
◦emphasize that unless a woman can
control her reproductive capacities,
she will not be able to pursue her
personal and professional interests as
well as a man can.
FEMINISTS’ ETHICS view
“access to family planning devices
such as contraceptives and
sterilization”
Responsible Parenthood and Reproductive Health
Act of 2012
◦defined as the premature termination of a
pregnancy resulting in the death of the
embryo or fetus, it is generally
understood to refer to the deliberate
termination of an unwanted pregnancy.
◦it is distinguished from miscarriage
ABORTION
interruption of a pregnancy before the 20th week of
gestation at the woman’s request for reasons other than
maternal health or fetal disease.
ELECTIVE ABORTION:
interruption of a pregnancy before the 20th week of
gestation because it endangers the mother’s life or health or
because the baby presumably would not be normal.
THERAPEUTIC ABORTION:
the expulsion of the products of conception before the 20th
week of gestation without deliberate interference
spontaneous abortions/miscarriage:
refers to the point at which the fetus is able to survive
independently of the mother
viability:
◦abortion has been banned entirely for
over a century
◦mandate imprisonment for women
who undergo abortion, as well as for
any person who assists in the
procedure
Revised Penal Code of the
Philippines
the implication that abortion is permissible in some cases but
not in others.
Judith Jarvis Thomson
argues that the right to life does not always
outweigh the right to decide what happens in and to one’s
own body or, more generally, that the right to life is not a right
to whatever one happens to need to go on living.
Thomson
There are various reasons why abortion
might be considered:
the woman is herself virtually a child
◦ the woman already has more children than she can manage
◦ having a child at this time will interfere with a career
◦ having a child at this time will involve loss of earnings
◦ the woman is a rape victim
◦ the woman is a sexually abused eleven-year-old
◦ the woman has already had three children by Caesarian section
◦ the woman was deserted by her partner when he learned of the pregnancy
◦ the woman is severely mentally defective
◦ the woman is homeless
◦ the fetus is believed to be defective
◦ the woman’s life or health is seriously threatened.
◦The oldest, well established procedure in cases
of untreatable male infertility which has been
regulated and submitted to standard medical
guidelines in most developed countries
Artificial Insemination:
When the husband’s semen is used
◦ homologous or from the husband
AIh:
Artificial Insemination by Donor
◦ Donor’s sperm is used
AID:
becoming
popular because many donor-conceived persons have a
desire and interest in finding out about where they came
from
Anonymous & non-anonymous sperm donations
◦ an attempt to reproduce while simultaneously
rendering reproduction not an act of personal
union but a technological procedure.
Artificial insemination by donor (Aid)
The principle of the inseparability of the unitive
and procreative meanings of sexuality demands
that:
a. the procreative purpose of the sexual act not be deliberately destroyed so as to render a
naturally fertile act sterile;
b. that the procreative purpose of the sexual act not be achieved in isolation from the unitive
expression of the couple’s love
a more radical erosion of the natural bond between
parent and child than AIH because it also involves a
violation of the nontransferable and inalienable rights
to procreation that married partners give one
another.
AId:
does not justify her obtaining a child by an act of
adultery
◦ semen donor himself is being sexually exploited like
a prostitute
AId:
◦a process whereby egg cells are fertilized by
sperm outside the womb.
in vitro fertilization (IVF):
◦involves removing a ripe egg from a woman
and in a glass (in vitro) mixing it with some
semen so that fertilization takes place
in vitro fertilization (IVF):
◦the resulting embryo is then transferred to a
woman’s uterus where it is hoped it will
implant and subsequently develop.
in vitro fertilization (IVF):
Terms of in vitro fertilization
Ectogenesis:
Embryo:
In vitro:
The creation and gestation of a human baby outside the maternal
womb
Ectogenesis:
A term for the developing human being during the first 8 weeks
after fertilization
Embryo:
Outside the human uterus
In vitro:
◦giving people the freedom to choose their
children in this way could lead to further
ethical problems
Sex selection:
◦The bearing of a child by a woman with the aim of turning
it over to another woman
surrogate motherhood
◦a woman who gives birth after carrying the fertilized
ovum of another woman or, more commonly, after
being artificially inseminated with sperm from the
biological father.
surrogate motherhood
◦thought to be a ‘treatment’ option for the infertile
◦an alternative to adoption
◦fulfill peoples desires to be parents
Surrogacy:
Problems & issues of Surrogate Motherhood
Question of morality
◦ Payment
◦ Exploitation
◦ Surrogate motherhood vs. conventional motherhood
Conflict of rights
◦ concern about surrogate mother hood involves the true nature of mothering
Question of morality
raises an ethical question around whether surrogacy is different from other kinds
of paid work
Payment
The infertile couple and the surrogate mother are highly vulnerable to
exploitation.
◦ “Womb renting”
Exploitation
Is “motherhood” merely the biological act of bearing children?
Surrogate motherhood vs. conventional motherhood
dispute revolves around who has the strongest claim to the child
Conflict of rights
◦a rapidly developing field that combines the efforts of
cell biologists, geneticists, and clinicians and offers
hope of effective treatment for a variety of malignant
and non-malignant diseases.
Stem cell technology
◦predominant methods being used to derive or attempt
to derive human embryonic stem cells require
destruction of the embryo
Stem cell technology
Issues and concerns in Stem cell technology
◦Oocyte harvesting
◦Embryo destruction
the crime of forcing somebody to have sex with one
especially with violence.
rape
an act of sexual violence that involves intercourse
without consent or against someone being willing to
engage in the act
(Brigneti and Egbonimali, 2002). rape
◦Sexual intercourse with a person below the
age of consent.
Satutory rape
Effects of rape
◦Physical trauma,
possible infection,
possible pregnancy
depression
anxiety,
PTSD,
sense of diminished self-worth and negative
sexuality issues
Issues:
◦Violation of basic human rights
◦Violation of personhood
◦Violation of sexuality as an expression of mutual love for
the sexual act to be performed
◦prevention of pregnancy raises special ethical problems
◦Ethical problems arise in the treatment of rape victims
when methods are proposed that probably prevent
conception but that
Care of victims:
- To offer the psychological support and counseling
- To provide medical care for injuries
- gather evidence to be used if the rapist is
apprehended and prosecuted.
- To provide treatment to prevent possible venereal
disease and pregnancy.
◦An act, whether of commission or omission, and
whether performed by himself or others, by which an
individual autonomously intends to bring about his
death because he wishes to be dead, either in order
to avoid a life he does not wish to live or as a means
to achieving some other purpose.
suicide
◦A feigned act of suicide (which may, but need not,
involve self-harm), at the end of which the protagonist
wishes, intends, and expects to be alive.
Gestured suicide
◦person who believes that in general we should
intervene in the suicidal acts of others because
suicide can never be in a person’s best interests
and/or because it is morally wrong.
Suicide conservative
◦person who believes that in general we should not
intervene in the suicidal acts of others because
autonomy is centrally important in the life of persons,
and thus we each have the right to do what we will
with our lives, even if we wish to give them up.
Suicide liberal
◦a general term that refers to documents that “formally
convey an individual’s wishes about medical
decisions to be made in the event that he or she
loses decision–making capacity”
Advance Directives:
Types of Advance Directives:
The living will
Durable power of attorney for health care/Medical power of attorney (DPOA-HC)
Physician Orders for Life-Sustaining Treatment
Do not resuscitate (DNR) orders
a legal document used to state certain future health care decisions only when a person
becomes unable to make the decisions and choices on their own
The living will
legal document in which you name a person to be a proxy (agent) to make all your health
care decisions if you become unable to do so.
Durable power of attorney for health care/Medical power of attorney (DPOA-HC)
A POLST form also helps describe your wishes for health care (not an advance directive)
Physician Orders for Life-Sustaining Treatment
medical staff will try to re-start your heart and breathing using methods such as CPR
(cardiopulmonary resuscitation) and AED (automated external defibrillator).
Do not resuscitate (DNR) orders
Limitations and issues of living wills &
dpoa-hc:
◦Address only a narrow range of end-of-life decisions
◦Preferences often change as they develop a progressive illness
or as their values or priorities change over time.
◦When DPOA-HC have joint appointments can create conflicts
and complications
a medical order written by a doctor where it instructs
health care providers not to do cardiopulmonary
resuscitation (CPR) if a patient’s breathing stops or if the
patient’s heart stops beating.
Do not resuscitate (dnr):
Some Issues on dnr:
DNR discussions are delayed until it is too late for the patients to
participate in decisions regarding resuscitation.
◦Physicians do not provide adequate information to allow patients to
make informed decisions
◦Physicians inappropriately estimate the value of DNR orders to limit
other treatments
◦Issues for those relying on religion as the main source for their moral
and ethical codes.
◦DNR was construed as either the patient was not worth to saving his/
her life or the family did not care enough to save the patient’s life.
Nurse’s responsibilities -Do not
resuscitate (dnr):
Clinical nurses actively participate in timely and frequent discussions on
changing goals of care and initiate DNR discussions with patients and their
families and significant others.
* Clinical nurses ensure that DNR orders are clearly documented, reviewed,
and updated periodically to reflect changes in the patient’s condition.
* nurses ensure that, whenever possible, the DNR decision is a subject of
explicit discussion between the health care team, patient, and family (or
designated surrogate), and that actions taken are in accordance with the
patient’s wishes.
* nurses facilitate and participate in interdisciplinary mechanisms for the
resolution of disputes among patients, families, and clinicians’ DNR orders.
◦also known as mercy killing, and assisted suicide
Euthanasia
◦Deliberately bringing about the death of a person
who’s suffering from an incurable disease or
condition, either actively or passively
Euthanasia
should allow people to die in dignity and
without pain
◦Beneficence:
our bodies are our own, and
we should be allowed to do what we want with them
◦Rights-based argument:
Euthanasia – CONS
◦The sanctity of life:
◦Euthanasia as murder:
◦The role of palliative care
◦The rights of vulnerable patients
◦The doctor-patient relationship and the physician’s role
◦”difficult or painful death, used to indicate the
extension of the dying process through treatment that
only prolongs patients’ biological life.
Dysthanasia
◦Also called Dysthanasia
◦Therapeutic intensification
◦ therapeutic obstinacy
◦ therapeutic fierceness
◦futility therapy or medical futility
term generally used when a person is kept alive
artificially, in a condition where otherwise they
cannot survive
Dysthanasia
◦A normal or natural manner of death and dying
Orthonasia
Possibilities for Orthonasia
- when the treatment to prolong life is useless or futile
- when the prolongation of life or the postponement
of death is unduly burdensome in the first place for
the patient and the family - when the patient needs painkillers or medical
sedation, which does not intend the death of the
patient.
Orthonasia (pros)
◦Death with dignity
◦Less sufferings
Orthonasia (cons)
◦Not respecting the sanctity of life
◦Allowing patient to die
◦patient who has decision-making capacity appropriate
to the decision at hand has the right to decline any
medical intervention or ask that an intervention be
stopped, even when that decision is expected to lead
to his or her death and regardless of whether or not
the individual is terminally ill.
Termination of Life-Sustaining
Treatment
When is it justifiable to discontinue
life-sustaining treatments?
◦If the patient has the ability to make decisions & fully
understands the consequences
◦If the treatment no longer offers benefit to the patient
Who are qualified to refuse treatment?
And be justifiable:
◦patients that have serious illness with limited life expectancy
◦Patients with advance directives
Nurse must ensure patient’s capacity to
make decisions:
▪ understands the clinical information presented
▪ appreciates his/her situation, including
consequences with treatment refusal
▪is able to display reason in deliberating about their
choices
▪is able to clearly communicate their choice.
End of Life Issues
Suicide
Gestured Suicide
Suicide Conservative
Suicide Liberal
Mechanical Barrier
Vaginal Diaphragm
Vaginal Ring
Cervical Cap
Condom
Chemical Barrier
Insertion of spermicidal foams
Creams
Jellies
Suppositories into vagina before intercourse
◦It is the crime of forcefully having sex with someone
against the person’s wish
Cheud, 2012
: life is given by God, and only God should decide when to
end it.
The Sanctity of Life
principle of autonomy forbids the voluntary ending of
LIFE
Euthanasia as murder
often argued that pain and suffering experienced by patients can be
relieved by administering appropriate palliative care
The role of palliative care
◦ coercion of patients receiving costly treatments to accept euthanasia
The rights of vulnerable patients
undermine the doctor-patient relationship, destroying the trust and
confidence built
The doctors-patients relationship and the physician’s role.
