Bioethics

Bioethics is a rather young academic inter-disciplinary field that has emerged rapidly as a
particular moral enterprise against the background of the revival of applied ethics in the second
half of the twentieth century. The notion of bioethics is commonly understood as a generic term
for three main sub-disciplines: medical ethics, animal ethics, and environmental ethics. Each
sub-discipline has its own particular area of bioethics, but there is a significant overlap of many
issues, ethical approaches, concepts, and moral considerations. This makes it difficult to examine
and to easily solve vital moral problems such as abortion, xenotransplantation, cloning, stem cell
research, the moral status of animals and the moral status of nature (the environment). In
addition, the field of bioethics presupposes at least some basic knowledge of important life
sciences, most notably medicine, biology (including genetics), biochemistry, and biophysics in
order to deal successfully with particular moral issues.

1. Preliminary Distinctions

Rapid developments in the natural sciences and technology (including biotechnology) have
greatly facilitated better living conditions and increased the standard of living of people
worldwide. On the other hand, there are undesirable consequences, such as nuclear waste, water
and air pollution, the clearing of tropical forests, and large-scale livestock farming, as well as
particular innovations such as gene technology and cloning, which have caused qualms and even
fears concerning the future of humankind

General goals of bioethics:

1. Discipline: Bioethics provides a disciplinary framework for the whole array of moral
questions and issues surrounding the life sciences concerning human beings, animals,
and nature.
2. Inter-disciplinary Approach: Bioethics is a particular way of ethical reasoning and
decision making that: (i) integrates empirical data from relevant natural sciences, most
notably medicine in the case of medical ethics, and (ii) considers other disciplines of
applied ethics such as research ethics, information ethics, social ethics, feminist ethics,
religious ethics, political ethics, and ethics of law in order to solve the case in question.
3. Ethical Guidance: Bioethics offers ethical guidance in a particular field of human
conduct.
4. Clarification: Bioethics points to many novel complex cases, for example, gene
technology, cloning, and human-animal chimeras and facilitates the awareness of the
particular problem in public discourse.
5. Structure: Bioethics elaborates important arguments from a critical examination of
judgements and considerations in discussions and debates.
6. Internal Auditing: The combination of bioethics and new data that stem from the natural
sciences may influence−in some cases −the key concepts and approaches of basic ethics
by providing convincing evidence for important specifications, for example, the
generally accepted concept of personhood might be incomplete, too narrow, or ethically
problematic in the context of people with disability and, hence, need to be modified
accordingly.

2. A Brief History of Bioethics

Historically speaking, there are three possible ways at least to address the history of bioethics.
First, by the origin of the notion of bioethics, second, by the origin of the academic discipline
and the institutionalization of bioethics, and third, by the origin of bioethics as a phenomenon.
Each focuses on different aspects concerning the history of bioethics; however, one can only
understand and appreciate the whole picture if one takes all three into account.

a. The Origin of the Notion of Bioethics

It is commonly said that the origin of the notion of bioethics is twofold: (i) the publishing of two
influential articles; Potter’s “Bioethics, the Science of Survival” (1970), which suggests viewing
bioethics as a global movement in order to foster concern for the environment and ethics, and
Callahan’s “Bioethics as a Discipline” (1973), in which he argues for the establishment of a new
academic discipline, and (ii) discussions between Shriver and Hellegers about the need for an
institute in which researchers should examine and analyse medical dilemmas by appealing to
moral philosophy (1970). This institute was created in 1971 as the Joseph and Rose Kennedy
Center for the Study of Human Reproduction and Bioethics, and is now known as the Kennedy
Institute of Ethics

b. The Origin of the Academic Discipline and Institutionalization of Bioethics

The origin of the discipline of bioethics in the USA goes hand in hand with the origin of its
institutionalization. At the beginning of this complex process, bioethics was seen as more or less
identical with medical ethics−the latter notion is first mentioned by Thomas Percival (1803)
−and was mainly conducted by philosophers, theologians, and a few physicians. Animal ethics
and environmental ethics are sub-disciplines which emerged at a later date. In the beginning, the
great demand for medical ethics was grounded in reaction to some negative events, such as the
research experiments on human subjects committed by the Nazis and the Tuskegee Syphilis
Study (1932–1972) in the USA.

c. The Origin of Bioethics as a Phenomenon

The notion of bioethics and the origin of the discipline of bioethics and its institutionalization in
academia is a modern development. The phenomenon itself, however, can be traced back, at least
with any certainty, to the Hippocratic Oath in Antiquity (500 B.C.E.) in the case of medical
ethics (Jonsen 2008) and possibly beyond if one considers the Code of Hammurabi (1750
B.C.E.), which contains some written provisions related to medical practice (Kuhse and Singer
2009: 4).

3. Sub-disciplines in Bioethics
a. Introduction
Bioethics is a discipline of applied ethics and comprises three main sub-disciplines: medical
ethics, animal ethics, and environmental ethics. Even though they are “distinct” branches in
focusing on different areas---namely, human beings, animals, and nature---they have a
significant overlap of particular issues, vital conceptions and theories as well as prominent lines
of argumentation. Solving bioethical issues is a complex and demanding task.

b. Medical Ethics
The oldest sub-discipline of bioethics is medical ethics which can be traced back to the
introduction of the Hippocratic Oath (500 B.C.E.). Of course, medical ethics is not limited to the
Hippocratic Oath; rather that marks the beginning of Western ethical reasoning and decision
making in medicine. The Hippocratic Oath is a compilation of ancient texts concerning the
proper behaviour of physicians and the relationship between physician and patient. It also
contains some binding ethical rules of utmost importance such as the well known principle of
non-maleficence (“primum non nocere”) and the principle of beneficence (“salus aegroti
suprema lex”); furthermore, doctor-patient confidentiality and the prohibition on exploiting the
patient (including sexual exploitation) are important rules that are still valid.

5. Theory in Bioethics

a. Introduction
Bioethics is an important inter-disciplinary and rapidly emerging field of applied ethics. The
traditional but deficient view concerning ethical reasoning and decision making in applied ethics
is that one simply “applies” a particular ethical theory such as utilitarianism or deontology in a
given context such as business (business ethics), politics (political ethics), or issues related to
human health (medical ethics) in order to solve the moral problem in question.

b. Deontological Approaches
Deontological approaches such as provided by Kant (1785) and Ross (1930) are commonly
characterized by applying usually strict moral rules or norms to concrete cases. Religious
approaches, such as those of the Catholic Church, and non-religious deontological approaches,
such as Kantian-oriented theories, are prime examples of applying moral rules.
c. Utilitarianism
One of the most prominent and influential ways of ethical reasoning and decision making in the
field of bioethics is based on utilitarianism. In the late twentieth century, utilitarian approaches
were so influential that many people outside academia believed that all bioethicists were
utilitarians. Utilitarianism, in fact, contains a wide range of different approaches, but one can
distinguish four important core elements that all utilitarian approaches have in common:
1. The consequence principle: The consequences of a given action are the measure of its
moral quality.
2. The utility principle: The moral rightness and wrongness of actions are determined by the
greatest possible utility for the greatest possible number of all sentient beings.
3. The hedonistic principle: The consequences of a given action are evaluated with
reference to a particular value. This particular prime value can be as follows: (1)
Promoting pleasure, or (2) avoiding pain, or (3) satisfaction of interests or considered
preferences, or (4) satisfaction of some objective criteria of well-being, and so forth.
4. The universal principle: Maximize the total utility for all sentient beings affected.
Utilitarian approaches in bioethics were spearheaded by Singer (1979) and Harris (1975) and
carried on by, among others, Savulescu (2001, 2002) and Schüklenk (2010). Such approaches in
bioethics are less concerned with public welfare than other vital aspects, such as: (1) debunking
the traditional religious views on the sacredness of human beings, the prohibition of abortion,
infanticide, and euthanasia; (2) stressing the importance of non-rational sentient animals (animal
ethics) and the preservation of nature (environmental ethics) against anthropocentric approaches
such as Kantianism and religious approaches; (3) arguing against the use of human rights and
human dignity in bioethical discourses; (4) maximizing the patient’s well-being or best interests
in medicine.

d. The Four-Principle Approach

One of the most important approaches in bioethics or medical ethics is the four-principle
approach developed by Tom Beauchamp and James Childress (1978, latest edition 2009). Since
then they have continually refined their approach and integrated the points of criticism raised by
their opponents, most notably Gert et al. (1990). The four-principle approach, often simply
called principlism, consists of four universal prima facie mid-level ethical principles:
(1) autonomy, (2) non-maleficence, (3) beneficence, and (4) justice. Together with some general
rules and ethical virtues, they can be seen as the starting point and constraining framework of
ethical reasoning and decision making (“common morality
(Gert et al. 1990).

e. Virtue Ethics
The revival of virtue ethics in moral philosophy in the last century was most notably spearheaded
by Anscombe (1958), MacIntyre (1981), Williams (1985), Nussbaum (1988, 1990), and more
recently Hursthouse (1987, 1999), Slote (2001), Swanton (2003), and Oakley (2009). This
approach also deeply influenced the ethical reasoning and decision making in the field of
bioethics, particularly in medical ethics (for example, Foot 1977, Shelp 1985, Hursthouse 1991,
Pellegrino 1995, Pellegrino and Thomasma 2003, McDougall 2007).

f. Casuistry
The revival of casuistry as an inductive method of ethical reasoning and decision making in the
second half of the twentieth century coincides with a wide and persistent critique of principle-
oriented approaches, most notably principlism, deontological ethics, and utilitarianism in
bioethics. Casuistry had its historical heyday in moral theology and ethics during the period from
the fifteenth to the seventeenth century in Europe. After a long time of no importance or
influence in moral philosophy, it gained a significant importance in bioethics---mostly in clinical
ethics---after the vital publications of Jonsen and Toulmin (1988), Strong (1988), and Brody
(1988). Casuists attack the traditional idea of simply applying universal moral rules and norms to
complex cases in order to solve the problem in question---that is, a moral theory justifies a moral
principle (or several principles) which in turn justifies a moral rule (or several rules) which in
turn justifies the moral judgement concerning a particular case. The circumstances make the case
and are of utmost importance in order to yield a good solution.

1. Depiction of the case: A thorough depiction of the empirical and moral elements of the
given case lays out the basic structure and the decisive problems. Vital questions are: (a)
 What are the particulars of the case (who, what, where, when, how much)? (b) What are
the basic questions in the relevant area (in medical ethics: what are the medical
indications, what are the patient’s preferences, evaluating the quality of life, consider and
respect the context of the treatment)?
2. Classification of the case: Once the given case is thoroughly depicted, one must classify
the case by finding paradigm cases and analogies by analogical reasoning. Paradigm
cases and analogies function as the background against which the given case is
evaluated. They help to determine the important similarities and differences of the
specifics of the case.
3. Moral judgement: Once the specific similarities and differences of the case are
determined, the casuists evaluate the results by adhering to common sense morality and
the basic values of the community.
g. Feminist Bioethics
Feminist bioethics can only be fully appreciated if one understands the context in which this
increasingly important approach evolved during the late twentieth century (Tong 1993, Wolf
1996, Donchin and Purdy 1999, Rawlinson 2001). The social and political background of
feminist bioethics is feminism and feminist theory with its major social and political goal to end
the oppression of women and to empower them to become an equal gender. The apparent
differences between men and women have often led cultures to treat them in radically different
ways, ways that often disadvantage women. Thus women have been allocated to social roles that
leave them worse off with respect to benefits enjoyed by men, such as freedom and power. Yet
despite their differences in reproductive roles, women and men share many morally relevant
characteristics such as rationality and the capacity for suffering, and hence deserve fundamental
equality.

Bioethicists often refer to the four basic principles of health care ethics when evaluating the
merits and difficulties of medical procedures. Ideally, for a medical practice to be considered
"ethical", it must respect all four of these principles: autonomy, justice, beneficence, and non-
maleficence. The use of reproductive technology raises questions in each of these areas.

4 PRINCIPLES OF BIOETHICS

Autonomy

Requires that the patient have autonomy of thought, intention, and action when making decisions
regarding health care procedures. Therefore, the decision-making process must be free of
coercion or coaxing. In order for a patient to make a fully informed decision, she/he must
understand all risks and benefits of the procedure and the likelihood of success. Because ARTs
are highly technical and may involve high emotions, it is difficult to expect patients to
be operating under fully-informed consent.
Justice
The idea that the burdens and benefits of new or experimental treatments must be distributed
equally among all groups in
society. Requires that procedures uphold the spirit of existing laws and are fair to all players
involved. The health care provider must consider four main areas when evaluating justice: fair
distribution of scarce resources, competing needs, rights and obligations, and potential conflicts
with established legislation. Reproductive technologies create ethical dilemmas because
treatment is not equally available to all people.
Beneficence
Requires that the procedure be provided with the intent of doing good for the patient
involved. Demands that health care providers develop and maintain skills and knowledge,
continually update training, consider individual circumstances of all patients, and strive for net
benefit.
Non-maleficence
Requires that a procedure does not harm the patient involved or others in society. Infertility
specialists operate under the assumption that they are doing no harm or at least minimizing harm
by pursuing the greater good. However, because
assistive reproductive technologies have limited success rates uncertain overall outcomes, the
emotional state of the patient may be impacted negatively. In some cases, it is difficult for
doctors to successfully apply the do no harm principle.
Application of Bioethics in the Care of Clients

The Role of Ethics in Nursing

Nurses work alone and with other healthcare professionals. This collaboration between nurses,
colleagues and physicians is important to the safety and quality of patient care. Nurses perform
duties based on physicians’ instructions and use their own judgment as necessary. Ethics in
nursing includes fair and equable treatment of all patients regardless of the following:
 Economic status.

 Age.

 Ethnicity.

 Citizenship.

 Disability.

 Sexual orientation.

The International Council of Nurses (ICN) defines nursing as follows:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families,
groups and communities, sick or well in all settings. Nursing includes the promotion of health,
prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a
safe environment, research, participating in shaping health policy and in patient and health
systems management, and education are also key nursing roles. (ICN, 2002)

The Ethical Responsibilities of Nurses

Nurses must maintain professional competency by continuing their education and participating in
professional development. The ethical responsibilities of nurses include promoting health,
preventing disease and alleviating suffering.
According to the Code of Ethics for Nurses with Imperative Statements (The Code), nurses are
responsible for the care not only of patients but also their families and associated groups. The
Code emphasizes that sometimes the patient is more than an individual. Thus, nurses need to
inform families, business associates or communities about a patient’s treatment and progress
when it is appropriate under patient privacy laws.

Morality and Ethics in Nursing

Nurses have a responsibility to report any immoral professional behavior. They should notify
staff leaders about healthcare professionals who engage in illegal activities, demonstrate
incompetence or work while impaired. In addition, nurses must intervene when they come in
contact with a patient who is a victim of child, elder, sexual or domestic abuse. They must also
report cases of tuberculosis and other infectious diseases.

Balancing Nursing Ethics with Job Performance

Ethical nursing constitutes a framework for optimal patient care. With ethics at the forefront,
nurses must balance the needs of their patients and the requirements of the healthcare systems
that employ them. The American Nurses Association (ANA) recommends that nurses see to the
following:
 Support and honor the rights of patients.

 Advocate for ethical nursing.

 Serve on ethics committees.

 Refuse to compromise ethics.

 Educate students about ethics.

Patient Rights
A nurse’s priority is to focus on the care and rights of their patients and put aside any prejudices
concerning a patient’s situation or demeanor. For example, a nurse must treat an incarcerated or
hostile patient the same as a law-abiding and amicable patient.
Patients have the right to make decisions about their healthcare. They can decide to accept or
refuse treatment. Patients should expect to receive accurate and complete information about their
conditions. Nurses must help their patients understand this information to determine their best
options.

Ethics in Nursing Education

Nurses can never infringe on a patient’s human rights. Nurses must also set boundaries with
patients to remain professional. They must be sensitive to a patient’s cultural and religious
beliefs, values, language, lifestyle and literacy level while caring for them. Patients trust nurses
to resolve conflicts, keep them safe and concentrate on their needs, all while telling the truth and
upholding ethics in nursing.

OUTCOME CRITERIA FOR:

Immunologic Reaction

As a nurse, you have a very important role when it comes to preventing infections. You are at the
front line when it comes to delivering quality care so you need to be aware of what can and can’t
compromise your patients’ health while they are in the hospital.

Risk Factors

A patient becomes at risk for infection if he is vulnerable to pathogenic organisms. It can be

related to any of the following:

 Invasive procedures
 Pharmaceutical agents, like immunosuppressants
 Increased exposure to pathogens
 Compromised circulation
 Break in the integrity of the skin
 Chronic disease
 Rupture of amniotic membrane
 Lack of immunization
 Inadequate primary defense, like tissue damage and broken skin
 Inadequate secondary defenses, like decreased hemoglobin and suppressed
 inflammatory response
 Trauma
 Insufficient knowledge regarding avoidance of pathogens

Desired Outcomes

 Remain free from signs of any infection

 Demonstrate ability to perform hygienic measures, like proper oral care and handwashing
 Demonstrate ability to care for infection-prone site
 Verbalize which symptoms of infection to watch out for
 Show capability to recognize symptoms of infection
Cellular Aberration

Risk for trauma as evidenced by high-risk personal behaviors

Natural defense mechanisms are inadequate to protect them from the inevitable injuries and
exposures that occur throughout the course of living.
Infections occur when an organism (bacterium, virus, fungus, or other parasite) invades a
susceptible host.
If the host's (patient's) immune system cannot combat the invading organism adequately, an
infection occurs.
Open wounds, traumatic or surgical, can be sites for infection; soft tissues (cells, fat, muscle) and
organs (kidneys, lungs) can also be sites for infection either after trauma, invasive procedures, or
by invasion of pathogens carried through the bloodstream or lymphatic system.

Transmission of Infection
Infections can be transmitted, either by contact or through airborne transmission, sexual contact,
or sharing of intravenous (IV) drug paraphernalia.
Being malnourished, having inadequate resources for sanitary living conditions, and lacking
knowledge about disease transmission place individuals at risk for infection.

Risk Factors:
Presence of adverse personal habits
Evidence of impaired perception
Low income
Lack of knowledge
Poor housing conditions
Risk-taking behaviors
Inability to communicate needs adequately (e.g., deafness, speech impediment)
Dramatic change in health status
Lack of support systems
Denial of need to change current habits

Expected Outcomes:
Patient describes positive health maintenance behaviors such as keeping scheduled
appointments, participating in smoking and substance abuse programs, making diet and exercise
changes, improving home environment, and following treatment regimen.
Patient identifies available resources.
Patient uses available resources.

Assess for physical defining characteristics

Assess patient's knowledge of health maintenance behaviors
Assess health history over past 5 years
Assess to what degree environmental, social, intrafamilial disruptions or changes have correlated
with poor health behaviors
Determine patient's specific questions related to health maintenance

Multi-Organ Failure

Approach Considerations
Treatment of patients with septic shock has the following three major goals:
 To resuscitate the patient from septic shock, using supportive measures to correct hypoxia,
hypotension, and impaired tissue oxygenation
 To identify the source of infection and treat it with antimicrobial therapy, surgery, or both
 To maintain adequate organ system function, guided by cardiovascular monitoring, and to
interrupt the pathogenesis of multiple organ dysfunction syndrome (MODS)
Current management principles used in addressing these goals include the following:

 Early recognition
 Early hemodynamic resuscitation
 Early and adequate antibiotic therapy
 Source control
 Continued hemodynamic support
 Corticosteroids (refractory vasopressor-dependent shock)
 Tight glycemic control
 Proper ventilator management with low tidal volume in patients with acute respiratory
distress syndrome (ARDS)

Recognition of septic shock requires identification of features of the systemic inflammatory

response syndrome (SIRS)—mental changes, hyperventilation, distributive hemodynamics,
hyperthermia or hypothermia, and a reduced, elevated, or left-shifted white blood cell (WBC)
count—along with the existence of a potential source of infection.
Patients in septic shock require immediate cardiorespiratory stabilization with large volumes of
intravenous (IV) fluids, infusion of vasoactive drugs, and, often, endotracheal intubation and
mechanical ventilation.
Empiric IV antimicrobial therapy should be immediately directed toward all potential infectious
sources.

Emergency and Disaster Preparedness

Emergency and disaster planning involves a coordinated, co-operative process of preparing to

match urgent needs with available resources. The phases are research, writing, dissemination,
testing, and updating. Hence, an emergency plan needs to be a living document that is
periodically adapted to changing circumstances and that provides a guide to the protocols,
procedures, and division of responsibilities in emergency response. Emergency planning is an
exploratory process that provides generic procedures for managing unforeseen impacts and
should use carefully constructed scenarios to anticipate the needs that will be generated by
foreseeable hazards when they strike. Plans need to be developed for specific sectors, such as
education, health, industry, and commerce.

Identifying and understanding risk: the foundation of risk reduction

Awareness, identification, understanding and measurement of disaster risks are all clearly
fundamental underpinnings of disaster risk management (UNISDR, 2015b). Disaster risk
reduction is about decisions and choices, including a lack of, so risk information has a role in
five key areas of decision making:

Risk identification

Because the damages and losses caused by historical disasters are often not widely known, and
because the potential damages and losses that could arise from future disasters (including
infrequent but high-impact events) may not be known at all, DRM is given a low priority.
Appropriate communication of robust risk information at the right time can raise awareness and
trigger action.

Risk reduction

Hazard and risk information may be used to inform a broad range of activities to reduce risk,
from improving building codes and designing risk reduction measures (such as flood and storm
surge protection), to carrying out macro-level assessments of the risks to different types of
buildings (for prioritizing investment in reconstruction and retrofitting, for example).
Preparedness

An understanding of the geographic area affected, along with the intensity and frequency of
different hazard events, is critical for planning evacuation routes, creating shelters, and running
preparedness drills. Providing a measure of the impact of different hazard events—potential
number of damaged buildings, fatalities and injuries, secondary hazards—makes it possible to
establish detailed and realistic plans for better response to disasters, which can ultimately reduce
the severity of adverse natural events.

Financial protection

Disaster risk analysis was born out of the financial and insurance sector’s need to quantify the
risk of comparatively rare high-impact natural hazard events. As governments increasingly seek
to manage their sovereign financial risk or support programs that manage individual financial
risks (e.g., micro-insurance or household earthquake insurance).

Resilient reconstruction

Risk assessment can play a critical role in impact modelling before an event strikes (in the days
leading up to a cyclone, for example), or it can provide initial and rapid estimates of human,
physical, and economic loss in an event’s immediate aftermath. Moreover, risk information for
resilient reconstruction needs to be available before an event occurs, since after the event there is
rarely time to collect the information needed to inform resilient design and land-use plans.
 Pangasinan State University
Bayambang Campus
Bayambang, Pangasinan
Institute of Nursing

Report in Oncology:

Principles, Concept and Application of Bioethics in the care

of the client
And Developing Outcome Criteria for Clients with problems
in Inflammatory and immunologic Reaction, Cellular
Aberration, Multi-Organ Failure, Including Emergency and
Disaster Preparedness

Submitted by:
Ferdinand S. Corpuz
BSN IV-A

Submitted to:
Ms. Susana S. Macabulos, MAN
Clinical Instructor