Isip, Erwin Gabriel C.

BS MD: 3Y1-1

I. Basic Ethical Principles - Ethical principles provide a generalized framework within which ethical dilemmas may be
analyzed, these principles can provide guidance in resolving ethical issues that codes of ethics may not necessarily
provide. If basic moral teachings dont always provide obvious answers in the most unusual medical cases, they at least
orient us toward making ethical decisions based on a clear set of values.
a) Stewardship
This principle is grounded in the presupposition that God has absolute Dominion over creation, and that, insofar as human
beings are made in Gods image and likeness (Imago Dei), we have been given a limited dominion over creation and are
responsible for its care. The principle requires that the gifts of human life and its natural environment be used with profound
respect for their intrinsic ends. Accordingly, simply because something can be done does not necessarily mean that it should
be done (the fallacy of the technological imperative). As applied to Catholic-sponsored health care, the principle of
stewardship includes but is not reducible to concern for scarce resources; rather, it also implies a responsibility to see that
the mission of Catholic health care is carried out as ministry with its commitment to human dignity and the common good .
A good example is, as Medical Professionals we are obliged to take care the lives of our patients, not only our patients but
also other people around us. In this way, we can live up to the dominion that God gave us to care for all His creations.
b) Totality
These principles dictate that the well-being of the whole person must be considered in deciding about any therapeutic
intervention or use of technology. Integrity refers to everyones duty to preserve a view of the whole human person in which
the values of the intellect, will, conscience, and fraternity are pre-eminent. Totality refers to the duty to preserve intact the
physical component of the integrated bodily and spiritual nature of human life, whereby every part of the human body exists
for the sake of the whole as the imperfect for the sake of the perfect. As an example, we, as Medical Technologist are
tasked to take care of our patients, and that doesnt just mean we are obliged to provide the proper diagnosis but we are
also obliged to take care of their totality, including their intellect, will and their intact component of their integrated bodily and
spiritual nature.
c) Double Effect
An action that is good that has two effects--an intended and otherwise not reasonably attainable good effect, and an
unintended yet foreseen evil effectis licit, provided there is a due proportion between the intended good and the permitted
evil. When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether
the obligation to avoid evil requires one to abstain from good action to prevent a foreseen but merely permitted concomitant
evil effect. The answer is that one need not always abstain from a good action that has foreseen bad effects, depending on
certain moral criteria identified in the principle of double effect. For example, a physician's justification for administering
drugs to relieve a patient's pain while foreseeing the hastening of death as a side effect does not depend only on the fact
that the physician does not intend to hasten death. After all, physicians are not permitted to relieve the pain of kidney stones
or childbirth with potentially lethal doses of opiates simply because they foresee but do not intend the causing of death as
a side effect
1. The object of the act must not be intrinsically contradictory to one's fundamental commitment to God and neighbor
(including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not
be intrinsically evil).
2. The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects
as far as possible, that is, one must only indirectly intend the harm.
3. The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other
means of achieving those effects are available.
4. The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate
judgment).
5. The beneficial effects must follow from the action at least as immediately as dote harmful effects.

d) Cooperation
Along with the principles of double effect and toleration, the principles of cooperation were developed in the Catholic moral
tradition as a way of helping individuals discern how to properly avoid, limit, or distance themselves from evil (especially
intrinsic evil) to avoid a worse evil or to achieve an important good. In more recent years, the principles of cooperation have
been applied to organizations or corporate persons (the implication being that organizations, like individual persons, are
moral agents). A good example of cooperation is during a surgery, the surgeon and its team need to cooperate in order to
achieve a successful surgery. Like the principle of double effect and some other moral principles, the principles of
cooperation are a constellation of moral criteria:

1. Formal and Informal Cooperation

Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares
in the agents intention, either for its own sake or to some other goal. Implicit formal cooperation occurs when, even though
 the cooperator denies intending the object of the principal agent, the cooperating person or organization participates in the
action directly and in such a way that it could not be done without this participation. Formal cooperation in intrinsically evil
actions, either explicitly or implicitly, is morally illicit.

2. Immediate Material Cooperation.

Immediate material cooperation occurs when the cooperator participates in circumstances that are essential to the
commission of an act, such that the act could not occur without this participation. Immediate material cooperation in
intrinsically evil actions is morally illicit. There has been in the tradition a debate about the permissibility of immediate
cooperation in immoral acts under "duress." When individuals are forced under duress (e.g., at gunpoint) to cooperate in
the intrinsically evil action of another, they act with diminished freedom. Following Church teaching, the matter of their action
remains objectively evil, but they do not intend this object with true freedom. In such cases, the matter remains objectively
evil as such, but the subjective culpability of the cooperator is diminished. Very recently, the Vatican has rejected the
arguments of those who would apply this concept of duress to Catholic organizations to justify their immediate material
involvement in certain objectionable actions.

II. Major Bioethical Principles

1. Respect for a Person
Respect for persons is the concept that all people deserve the right to fully exercise their autonomy. Any notion of moral
decision making assumes that rational agents are involved in making informed and voluntary decisions. In health care
decisions, our respect for the autonomy of the patient would, in common parlance, mean that the patient has the capacity
to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary
act. This principle is the basis for the practice of informed consent. For example, in any decision or move the Physician
makes, he/she should always consider the autonomy of the person, all of it should benefit to the individual without
disregarding the respect for the person.

2. Importance of free & informed consent

The concept of consent arises from the ethical principle of patient autonomy and basic human rights. Patient's has all the
freedom to decide what should or should not happen to his/her body and to gather information before undergoing a
test/procedure/surgery. No one else has the right to coerce the patient to act in a way. Even a doctor can only act as a
facilitator in patient's decision making. Personal liberty of action in which the individual determines his/her own course of
action in accordance with a plan chosen by him/herself; self-determination. Implies independence and self-reliance, freedom
of choice, and ability to make decisions. Informed consent involves clearly explaining the procedures, risks, and benefits of
the medical tests performed on the patients and taking their freely given consent, preferably in written form. For example,
study proposed a new wound healing technique and involved needle puncture on patients from two medical centers. It was
mentioned in the paper that an institutional ethical review board has given ethical approval for the study. However, the
process of puncturing, healing, and cleaning the vascular access cant be done without informed consent.
a) Patients right to information
The basis of this code is the Hippocratic Oath by which physicians are obliged to act always for the benefit of their patients.
The right to information can be understood as the updating of a partial aspect of this obligation. Citizens' interest in receiving
information on their own conditions arose from the demands of groups of AIDS patients, and was later extended to all layers
of society. The right to information is dealt with in a similar way in all the codes. The Catalan case can serve as an example:
Art. 22 Doctors are obliged to give patients as much information as possible on their state of health, the steps taken in the
diagnosis, the complementary investigations and the treatments. The information must be given in an understandable way
and exercising caution.

b) Proxy Consent
Whenever possible, informed consent on the part of the subject is ethically and legally necessary for every medical treatment
and research project. Sometimes, however, the subject is not able to give consent. For example, an aged person in a coma,
a two-month old child, or a fetus in the womb cannot perform the rational act necessary for informed consent even though
he or she may require some medical treatment. In such cases, another person is called upon to offer consent: this is called
proxy or vicarious consent. Proxy consent is not a subspecies of informed consent, rather it is a substitute for informed
consent and is sought when acquiring informed consent is impossible. For the ethical and legal use of proxy consent, two
conditions must be present: (1) the patient or research subject cannot offer informed consent; (2) the person offering the
consent ought to determine what the incompetent person would have decided where he or she able to make the ethical
decision. Decisions of proxy consent should be made in view of the good of the individual patient, not for the higher good
of society, nor for a class good, because this would amount to manipulation of the person. When deciding upon the treatment
for a comatose person dying of cancer, for example, the proxy must seek to determine what the patient would decide if able
to make the decision. What would benefit people other than the patient should not be considered unless it can be assumed
reasonably that this would have been the consideration of the person who is the patient.
 3. Principles of Justice
Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "Giving teach that which is his due."
This implies the fair distribution of goods in society and requires that we look at the role of entitlement. The question of
distributive justice also seems to hinge on the fact that some goods and services are in short supply, there is not enough to
go around, thus some fair means of allocating scarce resources must be determined.

a) Neighborly Relation - Elaboration and implementation of joint projects, aimed at disseminating information
on culture and traditions of their peoples, promoting mutual respect and good-neighborly relations between peoples.
Why should we maintain a good neighborly relation? Strong positive interpersonal relationships are essential to
achieving our success whether they be work relationships, family relationships or relationships with others in our
communities. Were in almost constant contact with others and we should make every contact an opportunity to
strengthen our social skills and reinforce our relationships. For example, maintaining a good neighborly relationship
between a Physician and his team will contribute in a greater expense.

b) Types of Justice
Distributive justice - also known as economic justice, is about fairness in what people receive, from goods to
attention. Its roots are in social order and it is at the roots of socialism, where equality is a fundamental principle. If
people do not think that they are getting their fair share of something, they will seek first to gain what they believe
they deserve. They may well also seek other forms of justice. Access to cancer pharmaceuticals provides a prime
example of violations of distributive justice. These drugs typically cost tens of thousands of dollars a year. Some
costs are stratospherically high. In terms of distributive justice, cancer medications are simply not available to those
who cant afford them. At costs of $10,000 per month, very few individuals can afford these drugs.
Procedural justice - The principle of fairness is also found in the idea of fair play (as opposed to the fair share of
distributive justice). If people believe that a fair process was used in deciding what it to be distributed, then they
may well accept an imbalance in what they receive in comparison to others. If they see both procedural and
distributive injustice, they will likely seek restorative and/or retributive justice.
Restorative justice - also known as corrective justice. The first thing that the betrayed person may seek from the
betrayer is some form of restitution, putting things back as they should be. The simplest form of restitution is a
straightforward apology. Restoration means putting things back as they were, so it may include some act of
contrition to demonstrate one is truly sorry. This may include action and even extra payment to the offended party.
For example, in an unsuccessful surgery, clinicians may develop their own coping strategies to help them deal with
what has happened. These can be positive, such as reflecting on and improving their skills, or more damaging,
such as dissociation and increased alcohol consumption that are often associated with burnout. Other studies have
shown that doctors can feel guilty when mistakes are made in a culture where failure is quite difficult to accept.
Retributive justice - Retributive justice works on the principle of punishment, although what constitutes fair and
proportional punishment is widely debated. While the intent may be to dissuade the perpetrator or others from future
wrong-doing, the re-offending rate of many criminals indicates the limited success of this approach. Punishment in
practice is more about the satisfaction of victims and those who care about them. This strays into the realm of
revenge, which can be many times more severe than reparation as the hurt party seeks to make the other person
suffer in return. In such cases 'justice' is typically defined emotionally rather that with intent for fairness or prevention.
A good example of this type of justice is the quotation An eye for an eye and tooth for a tooth

4. Beneficence
The ordinary meaning of this principle is the duty of health care providers to be of a benefit to the patient, as well as to take
positive steps to prevent and to remove harm from the patient. These duties are viewed as self-evident and are widely
accepted as the proper goals of medicine. These goals are applied both to individual patients, and to the good of society.
For example, the good health of a patient is an appropriate goal of medicine, and the prevention of disease through research
and the employment of vaccines is the same goal expanded to the population at large.

5. Inviolability of Life
It is a principle of implied protection regarding aspects of sentient life which are said to be holy, sacred, or otherwise of such
value that they are not to be violated. This can be applied to both animals and humans. The concept of inviolability is an
important tie between the ethics of religion and the ethics of law, as each seeks justification for its principles as based on
both purity and natural concept, as well as in universality of application.

Crimes Against Human Life - crimes against human life entail extermination, murder, enslavement, torture,
imprisonment, rape, forced abortions and other sexual violence, persecution on political, religious, racial and gender
grounds, the forcible transfer of populations and the enforced disappearance of persons.
Suicide - Suicide is defined as the intentional killing of oneself & by ones own authority. Suicide is immoral because
it contradicts natural law. Life is sacred, a gift from God. Life is simply given by God and to destroy its the verge of
 ingratitude, a sort of weariness to face the challenge of survival. But while someone may not extinguish his own life
directly, it is not suicide when he exposes himself to extreme.
Mutilation - Mutilation is the cutting of a limb or removal of an organ integral to the human body. The duty to preserve
life extends to the conservation of all bodily parts and function, therefore, the human body may not be mutilated
unless the motive is the preservation of life, thus a dangerous limb may be amputated since it imperils.
Sterilization - Sterilization is the most common method of contraception among married couples, with nearly twice
as many couples choosing female partner sterilization over male sterilization. Although sterilization is among the
most straightforward surgical procedures an obstetriciangynecologist performs, it is enormously complex when
considered from a historical, sociological, or ethical perspective. Sterilization practices have embodied a
problematic tension, in which some women who desired fertility was sterilized without their knowledge or consent,
and other women who wanted sterilization to limit their family size lacked access to it. An ethical approach to the
provision of sterilization must, therefore, promote access for women who wish to use sterilization as a method of
contraception, but at the same time safeguard against coercive or otherwise unjust uses.
Euthanasia - Euthanasia or mercy killing is an act of inducing death painlessly to abort the suffering of one afflicted
with an incurable or unbendable sickness. Euthanasia is regarded as homicide or murder.
Drug Addiction - Drug Addiction is the state of psychic or physical dependence, or both on a dangerous drug on
periodic or continuos basis.
Alcoholism - Alcoholism is the state of dependence on the stimulation of urine and liquor. In extreme cases,
alcoholism has the same evil effects of drug addiction. Alcoholism saps a person energy, dulls his mind and destroy
his capacity for creative activity, due to their erratic behavior and short span of attention, alcoholics are holding jobs
as well as establishing relationship with others. Drinking wine is not evil if done with moderation, intoxication,
however it is self-degrading.
Abortion - Abortion is the intentional expulsion of a fetus which cannot survive by itself outside of the womb of the
mother. In some countries, abortion is considered a legitimate means for regulating the size of the family or the
population in some countries. It is not only legalized but is encouraged by subdividing it with taxpayers money. The
Philippines however considers abortion a crime. Ethicist and theologies distinguish between direct and indirect
abortion. Direct abortion is intrinsically evil and always gravely immoral, whether chosen as an end because the
woman does not wish to be pregnant, or as a means to another end, because the termination of the pregnancy will
reduce the strain on an ill womans health. While indirect abortion is when the chosen act is inherently ordered, not
toward the death of the prenatal, but toward a good, such as the health of the mother. Then the death of the prenatal
is only a bad consequence in the third font of the morality.

6. Non-maleficence
The principle of non-maleficence requires of us that we not intentionally create a needless harm or injury to the patient,
either through acts of commission or omission. In common language, we consider it negligence if one imposes a careless
or unreasonable risk of harm upon another. Providing a proper standard of care that avoids or minimizes the risk of harm
is supported not only by our commonly held moral convictions, but by the laws of society as well. In a professional model of
care one may be morally and legally blameworthy if one fails to meet the standards of due care. An example is when an
elderly person received pain medication (an act of beneficence) there are complications that could arise. Practitioners
recognize that using a narcotic may cause confusion. When obtaining the consent for her surgery, we want to make certain
that the patient is alert enough to understand the risks and benefits of the procedure.

III. Applied Health Ethics

1. Informed Consent - Informed consent is the process by which the treating health care provider discloses appropriate
information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. It
originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical dut y
of the physician to involve the patient in her health care. For example, Children do not have the decision-making capacity
to provide informed consent. Since consent is given for an intervention for oneself, parents cannot provide informed
consent on behalf of their children. Instead they can provide informed permission for treatment.

2. Needs of a Dying Person - They may be practical, psychosocial, spiritual, legal, existential, or medical in nature. For
example, dying persons and their families are faced with choices about what kind of caregiver help they want or need
and whether to receive care at home or in an institutional treatment setting. Dying persons may have to make choices
about the desired degree of family involvement in caregiving and decision-making.

3. Role of Healthcare provider in caring for a dying person The healthcare provider may either provide Hospice care
or Palliative care for the dying person.
a) Hospice Care - A holistic and philosophical approach to end of life care, hospice brings doctors, nurses, social
workers and other professionals together as a care team. The hospice teams goal is to make the patient as
comfortable as possible during his or her final days. Hospice emphasizes pain control, symptom management,
natural death, and quality of life to comfort the patients physical body.
 b) Palliative Care - Palliative care works to achieve one of the primary goals of healthcarerelief of symptoms.
Palliative care is an option for patients who are seriously or terminally ill. It focuses on achieving the best
possible quality of life for a patient by emphasizing total and comprehensive care for all a patients needs: pain
and symptom management, spiritual, social, psychological, and emotional well-being. Palliative care is similar
to that of hospice care. However, palliative care is not restricted to patients near the end of life and can be used
in both acute and long term care settings.

4. Maternal and Fetal conflicts - maternal-fetal conflict includes a broad range of possible interventions, nonintervention,
and coercive influences ranging from refusal to serve alcohol to a pregnant woman to unwanted medical involvement
(Caesarean sections), and a refusal to follow medical instructions: bed rest, hospitalization. For example, fetal distress
indicates a need for a Caesarean section, but the 38-weeks-pregnant woman refuses to give her consent for the
operation, how does the practitioner evaluate the ethically significant features of the situation? First a review of viability
and the right to privacy: presumably a viable fetus can survive without the woman's body; privacy has provided grounds
for terminating a pregnancy, of being left alone, and patient autonomy is a cornerstone of medical ethics, balanced with
beneficence, the duty to protect or promote the welfare of the patient; where a pregnant woman and viable fetus are
viewed as patients, conflict ensues.

5. Artificial Insemination and In vitro Fertilization - All areas of medical practice are shaped by ethical and legal
mandates. When a physician provides infertility services, however, ethical and legal concerns reach an even greater
prominence. Clinicians performing in-vitro fertilization and artificial insemination should be especially sensitive to the
ethical concerns raised by the selection of patients and donors, the informed consent process, and record-keeping.

a) Artificial Insemination - is the introduction of semen into the vagina or cervix of a female by any method other
than sexual intercourse. There is evidence that people have been using artificial insemination to induce
pregnancy in animals for centuries, and in recent times this procedure has become so simplified that it can be
performed without the aid of a doctor or fertility specialist. It can be used to overcome both female infertility
problems (where the cervix or fallopian tubes pose barriers to normal insemination).
b) In Vitro Fertilization - Commonly known as 'Test Tube Baby' IVF involves fertilization of an ovum outside the
body and consequently transfer of embryo into the uterus of the woman. "In vitro" is Latin word mean "in glass",
which referred as the test tubes, however neither glass nor test tubes are being used; the term is used
generically for laboratory procedures. IVF is probably the most widely practiced assisted conception procedure
in the world. The procedure does not need admission at any step and is conducted on an outpatient basis. The
success rate for each in vitro fertilization cycle is around 20-30%. Many factors affect success rates, including
patient age, sperm and egg quality, reproductive health, duration of the infertility, and medical expertise.
Because multiple embryos are often transferred, the risk of multiple births is the major complication in IVF.

6. Suffering occurs when we perceive or experience a threat to or loss of our wholeness. Wholeness includes an
individual's cognitive, emotional, spiritual, and physical conditions, which are inherently interrelated. Suffering has a
variety of causes and effects. Suffering may be the result of personal choices, or other's choices, or may come without
obvious reason or explanation. Disease and injury may contribute to suffering in humans and animals. For example,
suffering may be a feature of mental or physical illness such as borderline personality disorder and occasionally in
advanced cancer. Health care addresses this suffering in many ways, in subfields such as medicine, clinical psychology,
psychotherapy, alternative medicine, hygiene, public health, and through various health care providers.

7. Death The irreversible cessation of life; permanent cessation of all vital bodily functions. For legal and medical
purposes, the following definition of death has been proposed-the irreversible cessation of all the following: (1) total
cerebral function, usually assessed by EEG as flat-line (2) spontaneous function of the respiratory system, and (3)
spontaneous function of the circulatory system.

8. Health Professional Relationship - The relationship established between patients and health care providers is
fiduciary in nature, which means that it is based on trust. The professional trusts the patient or client to disclose all the
information that may be relevant to his or her condition or illness, and to be truthful while disclosing it. In return, the
patient or client trusts the health care professional to maintain high standards of competence; to protect the
confidentiality of private information; and to carry out his or her work in the best interests of the patient rather than taking
advantage of the patient's vulnerability.

References:
https://www.acog.org http://missinglink.ucsf.edu www.lesd.k12.or.us
http://opcentral.org http://study.com https://www.slideshare.net
https://www.scribd.com www.hsj.co.uk https://www.wikipedia.com
http://www.nursingworld.us http://beyondintractability
Isip, Erwin Gabriel C. BS MD:3Y1-1

MEDICAL TECHNOLOGISTS CODE OF ETHICS

As I enter into the practice of Medical Technology, I shall accept the responsibilities inherent to being a professional; I
shall uphold the law and shall not engage in illegal work nor cooperate with anyone so engaged; I shall avoid
associating or being identified with any enterprise of questionable character;

I shall work and act in a strict spirit of fairness to employer, clients, contractors, employees and in a spirit of personal
helpfulness and fraternity toward other members of the profession;

I shall use only honorable means of competition for professional employment or services and shall refrain form
unfairly injuring, directly or indirectly, the professional reputation, projects or business of a fellow medical technologist;
I shall accept employment from more than one employer only when there in no conflict of interest;

I shall perform professional work in a manner that merits full confidence and trust carried out with absolute reliability,
accuracy, fairness and honesty; I shall review the professional work of other medical technologists, when requested,
fairly and in confidence whether they are subordinates or employees, authors of proposals for grants or contracts,
authors of technical papers or other publications or involved in litigation;

I shall advance the profession by exchanging general information and experience with fellow medical technologists
and other professionals and by contributing to the work of professional organizations;

I shall restrict my praises, criticisms, views and opinions within constructive limits and shall not use the knowledge I
know for selfish ends; I shall treat any information I acquired about individuals in the course of my work as strictly
confidential, and may be divulged only to authorized persons or entities or with consent of the individual when
necessary;

I shall report any infractions of these principles of professional conduct to the authorities responsible of enforcement
of applicable laws or regulations, or to the Ethics Committee of the Philippine Association of Medical Technologists as
may be appropriate.

To these principles, I hereby subscribe and pledge to conduct myself at all times in a manner befitting the dignity of
my profession.