HEALHEALTHCARE
ETHICSTHCARE
HEALTHCARE ETHICS
ETHICSETHICS 3
WILLYN BATAGA ADRIAS, RN.MN.
Bioethics and its Application in Various Health Care Situations
I: Sexuality and Human Reproduction
A. Human Sexuality and its Moral Evaluation
B. Marriage
C. Issues on Artificial Reproduction, Its Morality
D. Morality of Abortion, Rape, and other Problems
Related to Destruction of Life
HUMAN SEXUALITY
Sexuality is about your sexual feelings, thoughts, attractions
and behaviours towards other people.
Metaphysics of Sexuality
1. Metaphysical Sexual Pessimism
2. Metaphysical Sexual Optimism
Pessimist Optimist
St. Augustine Plato
Immanuel Kant Sigmund Freud
Bernard Baumrim Bertrand Rusell
Metaphyiscal Sexual Pessimism
perceive the sexual impulse and acting on it to be something nearly
always, if not necessarily, unbefitting the dignity of the human person
they fear that the power and demands of the sexual impulse make it a
danger to harmonious civilized life
they find sexuality a severe threat not only to our proper relations with,
and our moral treatment of, other persons, but also equally a threat to
our own humanity.
they judge that sexuality, which in some measure has been given to us
by evolution, cannot but be conducive to our well-being without
detracting from our intellectual propensities; and they praise rather
than fear the power of an impulse that can lift us to various high forms
of happiness.
St. Augustine
Augustine uses to describe his sexual impulses is negative, reflecting
images of disease, disorder, and corruption. Desire is mud, chains,
thorns, a seething cauldron, and an open sore that must be
scratched.
Immanuel Kant
Sex, says Kant, “makes of the loved person an Object of appetite. . . .
Taken by itself it is a degradation of human nature”
Bernard Baumrim
“sexual interaction is essentially manipulative—physically,
psychologically, emotionally, and even intellectually”.
Metaphysical Sexual Optimism
sexuality is a bonding mechanism that naturally and happilly joins
people together both sexually and nonsexually.
sexual pleasure is a valuable thing in its own right
sexuality in itself is neither good nor bad, that there can be morally
bad and morally good sexual activity (Pausanias, in Plato’s Symposium
Distinction between what he calls “vulgar” eros and “heavenly” eros.
A person who has vulgar eros is one who experiences promiscuous sexual desire, has a lust
that can be satisfied by any partner, and selfishly seeks only for himself or herself the
pleasures of sexual activity.
a person who has heavenly eros experiences a sexual desire that attaches to a particular
person.
MORAL EVALUATION ON HUMAN SEXUALITY
inquire whether a sexual act—either a particular occurrence of a
sexual act (the act we are doing or want to do right now) or a type of
sexual act (say, all instances of homosexual fellatio)—is morally
good or morally bad.
EXECUTIVE ORDER NO. 209:
THE FAMILY CODE OF THE PHILIPPINES
Marriage
is a special contract of permanent union between a man and a
woman entered into in accordance with law for the establishment
of conjugal and family life.
THE 1987 CONSTITUTION OF THE REPUBLIC OF THE PHILIPPINES –
ARTICLE XV
Marriage, as an inviolable social institution, is the foundation of
the family and shall be protected by the State.
Issues on Sex
St. Aquinas and other Natural Law theorists would say that our
sexual faculties have one true end — procreation.
True, sex is pleasurable but it is pleasurable in order to fulfill
this end.
If this is correct then sexual activity is good if, and only if, it is
consistent with procreation and bad in so far as it frustrates
that end.
premarital sex is wrong because children would be brought into
the world outside the safe confines of marriage.
Homosexual acts have no tendency towards procreation at all;
contraception frustrates procreative ends
The Roman Catholic belief is that when a man and woman
connect to each other in a sexual way, it is the most intimate
physical expression of their total union.
For this reason, the Roman Catholic Church teaches in
Familiaris consortio that this union is sacred and is a key
element in marriage.
Most Christians accept the teaching that sexual relationships
should only happen in marriage.
This is supported by one of the Ten commandments;
“Thou Shall Not Commit Adultery”
Adultery - is committed by any married woman who shall have sexual
intercourse with a man not her husband and by the man who has carnal
knowledge of her knowing her be married, even if the marriage be
subsequently declared void.
Concubinage - any husband who shall keep a mistress in the conjugal
dwelling, or shall have a sexual intercourse, under scandalous
circumstances, with a woman who is not his wife,or shall cohabit with
her in any other place, shall be punished by prison correctional in its
minimum and medium periods.
CONTRACEPTION
CONTRACEPTION
refers to a direct and positive method of
preventing conception before, during or after
the act of sexual intercourse
DIRECT METHOD
contraception is directly willed either as an end of the
means or a means to attain another end.
Ex:
A married woman who does not want to conceive a
child, so she takes “oral contraceptives.” - woman’s
means to attain her end of preventing conception is to
take a contraceptive pill. (the act is directly willed)
A woman takes the prescribed medication
(contraceptive) for direct motive of healing
endometriosis whose inevitable evil side effect is
sterility. - Principle of Double Effect
POSITIVE METHOD
is meant the means used is deliberately arbitrary and determinate,
and as such, is not a part of the natural processes of sexual system,
causing frustration of the generative faculty for conception.
Ex:
the use of condom is an arbitrary and determinate means of
preventing sperms from entering the vaginal canal to unite with the
egg.
it is not part of the natural design of the degenerative stucture.
it is different from the negative methods or means in which there is
nothing that is arbitrarily done to suppress the generative power or
faculty so that the process goes on as naturally - Ex: Rhythm
method
Is contraception moral?
Church - Contraception is evil not because the Church prohibits it,
rather; the Church prohibits contraception because it is evil.
Where in itself is the EVIL of contraception reside?
The evil of contraception resides in its defiance of the will of God indicated in
the law of nature.
1. Arbitrary frustration of the generation of New Life
contraception deliberately frustrates by positive means, the natural power of
marital intercourse to generate life.
2. Arbitrary separation between the Unitive and Procreative meanings of
conjugal act.
contraception deliberately and arbitrarily excludes the procreative aspect from
the unitive aspect of the conjugal act.
3. Distortion of the language of Human Sexuality
contraception distorts the overall language of human sexuality by limiting it
within the biological and physiological structure of the sexual act.
What about a specific health care administered with
contraceptive effects?
Is it morally justified to provide a medical intervention whose
effect is contraceptive?
Medications and surgical procedures whose actions are
contraceptive are indifferent acts. ( any action that is
neither good nor bad)
• if they are employed as direct methods - evil
• if they are done to treat a condition to save patient’s life
(principle of double effect) - morally justified.
NATURAL FAMILY PLANNING
also called periodic abstinence methods
methods that involve no introduction of chemical or
foreign material into the body.
13th - 15th century: influenced by Augustinian Theology
marital intercourse could only be done if procreation would
directly be desired and actually be possible intercourse during
infertility period, menstruation, and pregnancy in which the
transmission of life could not occur was morally prohibited.
Is Natural Family Planning Moral?
Natural family planning does not directly and
positively interfere with the natural processes of the
generative mechanism.
It is in accordance with the natural rhythm of how
the sexual system is structured
• fertility, infertility
Considers validity of reason and motives - whether health
related, eugenic, or socio-economic (Pope Pius XII)
Elements of guilt of contraception in natural family planning:
Pope Pius stated:
If, however, in the light of a reasonable and fair
judgement, there are no such serious personal
reasons (health, eugenics), or reasons deriving from
external circumstances (socio-economic), then, the
habitual intention to avoid the fruitfulness of the
(sexual) union, while at the same time continuing fully
to satisfy sensual intent, can only arise from a false
appreciation of life and from motives that run counter
to true standards of moral duct.
Arguments:
Opponents say that human beings interfere with the
natural order of the universe all the time (for example
when doctors cure illnesses) - sometimes the results
are good and sometimes bad
Therefore birth control is only a wrong interference with
the natural order of the universe if it produces a bad
result so it's necessary to look at the consequences of
contraception to assess whether it is good or bad.
Contraception is anti-life
This argument is based on the premise that life is a good thing.
Holders of this view argue that contraception is morally wrong
because:
life is a fundamental good - it is a good thing
those who use contraception are engaged in an intentionally
"anti-life" act
because they intend to prevent a new life coming into being
they therefore have a bad intention
it is always morally wrong to do something with a bad intention
Contraception is a form of abortion
Some birth control techniques can operate by preventing the
implantation and development of a fertilized egg.
Those opposed to such methods say that this amounts to an
abortion, and that if abortion is wrong then those forms of
contraception must also be wrong.
The forms of contraception included in this objection are:
some birth control pills
most modern birth control pills can prevent implantation of a fertilized
egg, even though this is not the main way they work
there is no way for the user to know after any act of intercourse whether
the pill prevented implantation (or worked in some other way)
therefore using such pills always runs the risk of causing an abortion
it is wrong to run the risk of causing an abortion
IUD - this can operate by preventing implantation of a fertilized egg
Arguments based on sexual behaviour and health
The danger of the "contraceptive culture"
Some people are concerned that "the availability of
contraceptives leads to promiscuity which then leads to
abortion".
Judie Brown, the founder and president of the American Life League, explains :
"The contraceptive mentality suggests that man and woman have absolute
and total control over their reproductive lives. Once you have that mindset
and the contraceptives fail, then you can eliminate that problem [the
pregnancy] as well."
(Washington Monthly 1991)
Positive Reasons why people believe that it is right to
allow people to practice birth control
Human rights benefits
Health benefits
Family benefits
Benefits for women
Issues on Artificial Reproduction, Its Morality and Ethico-Moral
Responsibility of Nurses
Artificial insemination
– is a fertility treatment
method used to deliver
sperm directly to the
cervix or uterus in the
hopes of getting
pregnant.
Artificial insemination is intrisically evil on the following
grounds:
1. Transgression of the Will of God Expressed in the Law of
Nature
- the defiance of the law of nature takes variety of forms,
namely:
a) Arbitrary exclusion of the marital act from procreation
b) Distortion of the measning and purpose of sexuality
2. Usurpation of God’s Creative Power of Authority Over Life
3. Against Human Dignity
Moral Distinctions among Categories of Artificial Insemination:
1. Artificial insemination by husband -(homologous)
the production of semen by means of masturbation and how it is
inseminated, that is, by ways other than the naturally fertile
intercourse for procreation mainly constitute the moral problem of
artificial semination.
it is a violation of the will of God in the order of nature, a
usurpation of God’s authorship over life, and against human
dignity and worth.
2. Artificial insemination outside marriage.
the natural law dictates that the procreation of a new fe may only
be the fruit of marriage.
Moral Distinctions among Categories of Artificial
Insemination:
3. Artificial insemination by Donor (Heterologous)
this category is substancially an adulterous
procedure.
only marriage partners have mutual rights over
their bodies for the procreation of a new life, and
these rights are exclusive and non-transferable
Are impotent and sterile individuals who desire to
foster marriage morally excused from the moral
prohibition against recourse to artificial insemination?
Impotence and sterility are not excusable reasons
for the moral justification of artificial insemination.
no amount of good intention and surrounding
circumstances however great can make objectively
evil act good.
the end does not justify the means
In-vitro fertilization – is a
procedure in which eggs are
removed from a woman and
fertilized in a laboratory dish (by
either the husband or another
man).
The First Test Tube Baby
Louise Brown (July 25, 1978) - the first baby conceived in a Petri-dish
was born
Dr R.G. Edwards and Dr. Patrick Steptoe of Britain were the medical
scientists who produced Louise through in vitro fertilization.
Moral Teaching on the Transmission of Life
Humanae Vitae (“Of Human Life”): Pope Paul VI
conjugal (marital) act, while most closely uniting husband and wife
(unitive), capacitates them for the generation of new lives
(procreative) according to laws inscribed in the very being of man and
woman
Is In Vitro Fertilization Moral?
Violation of the Will of God manifested in the Biological Law of Nature
Usurpation of god’s,, power of authorship over life and death
Transgression of human dignity
Grave abuse of the Principle of Stewardship
Threat against the whole concept of marriage and family
Surrogate motherhood – occurs when a woman agrees to carry a
baby to term and give it up to another set of parents to raise.
