Principle of Human Creative Sexuality The gift of sexuality must be used in keeping with its intrinsic, indivisible, specifically

y human teleology. It must be a loving, bodily, pleasurable expression of the complementary, permanent self-giving of a man and a woman to each other which is open to fruition in the perpetuation and expansion of this personal communion through the family they responsibly beget and educate.

Basic Concepts/Values Recognized in Sexuality 1. 2. Sex is a search for sensual pleasure & satisfaction, releasing physical & psychic tensions. Sex is a search for the completion of the human person through an intimate personal union of love expressed by bodily union. Sex is a social necessity for the procreation of children. Sex is a symbolic mystery, somehow revealing the cosmic order.

3. 4.

KEY POINTS: Sex is not always a proof of love, although often it is demanded as such. There is inseparable connection, established by God, which man in his own initiative may not break, between the unitive significance and the procreative significance, both inherent to the marriage act.

ON MARRIAGE AND CONJUGAL LOVE Fundamentals of Marriage Mans cooperation in the creative power of God. Hence, man becomes Gods co-creator. Vehicle in the transmission of life and preservation of human race. Instrument in the establishment of the human family and its education.

Conjugal Love Highest expression of union between man and woman. Originates from a supreme origin, God, Who is Love. Not an effect of chance or product of evolution of unconscious forces. For baptized persons, represents the union of Christ and of the Chu

CHARACTERISTIC OF CONJUGAL LOVE

Human
Total

> Faithful and Exclusive

> Fecund (bountiful, fruitful)

Any use of sex outside marriage is ethically wrong, because 1. It is a selfish pursuit of pleasure apart from love 2. It expresses love, but not a committed love involving true self-giving 3. It is committed, but practiced in a way contradictory to its natural fulfillment in the family Issues in Marriage and Sexuality 1. Genetic Testing/ Screening 2. Prenatal diagnosis 3. Genetic Interventions 4. Sex selection of offspring 5. Artificial Insemination 6. In Vitro fertilization (IVF) 7. Surrogate motherhood 8. Sperm and zygote banking 9. Sex Change operations 10. Cloning

Contraception > Voluntary prevention of conception by the positive use of artificial means which hinders the generative cells from uniting during the sexual act > Prevention of conception rather than prevention of birth Methods of Contraception > Folk methods > Mechanical > Chemical > Hormonal > Abortifacients

* Any conjugal act must be open to the transmission of life. - By its very nature, contraception is immoral since it contemplates the prevention of procreation. - Once a new life is conceived as the result of the union of the sperm and the egg cell, it can no longer be controlled or prevented from coming out, dead or alive

Natural Family Planning A way of thinking and living that is adapted voluntarily upon the basis of knowledge, attitudes and responsible attitudes and decisions by individuals and couples in order to promote health and welfare of the family group WHO A way of life by which properly instructed couple can achieve or avoid pregnancy by appropriate sexual behavior during the fertile and infertile phases of the menstrual cycle without using drugs, chemicals or mechanical devices 1. Rhythm or Calendar Method 2. Ovulation method or Billings method 3. Sympto- thermal method 4. Sex relation during menstruation Questionable Issues in Contraceptives 1. Anti-Sexuality 2. Anti-Love 3. Anti-Health 4. Anti-Person

ABORTION Expulsion of a living fetus from the mothers womb before it is viable (20weeks) Types: 1. Spontaneous 2. Induced - direct - indirect The direct and voluntary killing of an innocent human being is always gravely immoral even when it is performed as a means to a good end Indirect abortion may be justified by the principle of double effect

ARGUMENTS: PRO ABORTION AND LIBERALIZATION 1. To safeguard the life of the mother. 2. Abortion as a womans right. 3. Abortion as an expression of a womans sexual freedom.

4. The fetus is not human. 5. The unwanted child syndrome. 6. To save off the birth of a potentially deformed child. 7. Abortion as a means of improving the quality of life. 8. Abortion as a means of controlling the population. ARGUMENTS: CONTRA ABORTION 1.Not a flimsy choice between a mother or child. But, must center on saving both lives. 2. Unselfish love and solicitude to an innocent creature. 3. Complimentary roles between man and woman. 4. It has genetic code totally different from the cells of the woman (or of the father). 5. What about retarded people, sick, weak - to some degree unwanted. 6. Life can be enjoyed by all people - be they normal or handicapped. (1971) 7. Many alternatives to eliminate poverty, educate youth and improve health care services. 8. There are many ways to control population growth. * Human life is sacred and must be protected and respected absolutely from the moment of conception. From the first moment of his/her existence, a human being must be respected and recognized as having the rights of a person among which is the inviolable right of every innocent being. This inalienable right must be recognized and respected by civil society and political authority RAPE

Most common social crime motivated by hostile impulses A desire to assert aggressive powers by the rapist and to humiliate the victim- more than the desire for sexual pleasure It is a violation of natural sexual activity, which should be an act of mutual love

Care of Rape Victims Offer psychological support and counseling that the woman needs to overcome the trauma of attack; often, this will require follow-up treatment Provide medical care for injuries or abrasions that might have occurred Gather evidence to be used if the rapist is apprehended Provide treatment to prevent venereal disease and pregnancy

Victim did not consent to the sexual act; therefore has the right to use any ethical means to avoid conception However, if the woman has already conceived she cannot take action to abort or destroy the fertilized ovum She has the right to protect herself from the effects of the aggression but not at the expense of the unborn innocent child

Universal Ethical Principles I. Principle of Autonomy The right of the patient to accept or refuse the physicians treatment. His option to choose is based on respect of his free will

Implications of the Patients Autonomy The patient is responsible for his choices & decisions. His human dignity is upheld & recognized His personal value & worth are affirmed His patients rights are protected & are not unduly interfered with He cannot be constrained or forced to make decisions & perform actions against his will Forms of Defiance of the Patients Autonomy 1. Employment of intervention without the use of the patients personal capacity to make his choices & decisions 2. Employment of intervention against the patients choices & decisions. 3. Omission of an intervention that is in agreement with the patients choice & decision. 4. Withdrawal of the services of a health care professional & making a referral of the case without the informed choice of the patient Essential Elements: a. The doctor promises to treat his patient according to his best judgment. b. The doctor, although he believes he knows best, should fully inform his patient and defer to the latters option to accept or reject the proposed plans of management. c. When the patient is incompetent, proxy consent should be sought. d. The patients right to decide is called autonomy and should be respected unless his actions constitute an evil act. Patients Rejection to Health Care If the pt refuses health care, it is the moral obligation of the health care practitioners to make it a point to reverse his decision so that they may receive the said means of care. ( instructions, persuasions) Necessary charting of nurses pertaining to refusal future legal reference Sign a waiver exonerate from legal indictment Principle of Free and Informed Consent To protect the basic need of every human person for health care and the persons primary responsibility for his or her own health, (1) no physical or psychological therapy maybe administered without the free and informed consent of the patient, or, (2) if the patient is incompetent, the persons legitimate guardian acting for the patients benefit and, as far as possible, in accordance with the patients known and reasonable wishes. Elements of Free & Informed Consent 1.Disclosure 2. Understanding 3. Competence 4. Voluntariness 5. Consent Who are incompetent? - Comatose - Below 18 yrs old

Mentally incoherent

Who gives proxy consent? 1. Closest of kin 2. Durable Power of attorney PATERNALISM The doctor can decide: 1. Doctor can act as loco-parentis 2. If it is a matter of life and death 3. Court Deliberate restriction of peoples autonomy by health care professionals based on the idea that they know whats best for the clients- can be justifiable at times Doing good should take precedence over autonomy

Principle of Confidentiality and Privacy - Requires the non-disclosure of private or secret information with which one is entrusted - ICN (2000)- the nurse holds in confidence personal information and uses judgment in sharing this information - An important component of autonomy- maintains dignity and respect for the person PRINCIPLE OF CONFIDENTIALITY To whom should medical information regarding the patient be disclosed? 1. To the patient 2. Whoever is in charge (pt unable to comprehend info) 3. Those who maybe affected by the patients health 4. To other legitimate authorities The following are subjects of Confidentiality and should not be revealed to anyone except for graver cause: 1. Private Secrets 2. Contractual Secrets 3. Professional Secrets Graver Cause: 1. Personal decision 2. Reportable cause 3. Legal case VERACITY Duty to tell the truth

Fundamental to the development and continuance of trust among human beings

SOME TIPS TO DELIVER BAD NEWS WELL 1. Serious matters about ones health should be discussed face to face in a quiet, comfortable, private place, not in the hall, on the phone or in the middle of the ground rounds with half a dozen strangers listening. 2. Ideally, a caring relative or friend should be present to provide emotional support and assist in gathering critical information. 3. When imparting bad news the physician should allow an open-minded amount of time free of interruption, sit close to the patient at eye level, look directly to the patient and, if appropriate, touch the patient. 4. Patients should be given as much information as needed to understand the condition, its treatment and the likelihood that treatment will cure the illness or control its symptoms. 5. Treatment options and the reasons for more tests should be clearly described along with their likely or possible side effects so that people (patients) can make intelligent choice.

Principle of Truthful Professional Communication Healthcare professionals responsibilities: To strive to establish & preserve trust at both the emotional & rational levels To share such information as they possess which is legitimately needed by others in order to have an informed conscience To refrain from lying or giving misinformation. To keep secret information which is not legitimately needed by others & that if revealed might harm the patient or others or destroy trust. FIDELITY OBLIGATION OF AN INDIVIDUAL TO BE FAITHFUL TO COMMITMENTS TO HIMSELF OR HERSELF AND ALSO TO OTHERS MAIN SUPPORT FOR THE CONCEPT OF ACCOUNTABILITY

Principle of Beneficence & Nonmaleficence Beneficence Duty to actively do good for patients

Hippocratic Oath

Nonmaleficence Duty to prevent or avoid harm or evil Principle of double effect

Violations of the Principle of Nonmaleficence: Physically harming a person as in suicide, abortion, infanticide, mutilation, torture & violence Exposing a person to physical harm as in subjecting a person unnecessary treatment or to a dangerous procedure without a commensurate important goal Harming a persons reputation, honor, property or interests as by revealing confidential information Withholding information needed by a person to make an informed decision or protect himself against harm Causing unnecessary expense for the patient Increasing patient/family anxiety by failure to use proper communication skills Failure to provide spiritual counsel

Elements in the Principle of Beneficence and Nonmaleficence: 1. Act thoughtfully and carefully 2. Consider potential risks involved in any treatment 3. Follow standards of medical practices in his/her community, the courts, and medical practice.

Principle of Justice The duty to treat all patients fairly Equal treatment of equal cases and equal distribution of benefits

Involves allocation of scarce and expensive health care resources

What is due an indvl is determined by: Either he gets what he deserves by right, independent of the claims of others (non-comparative justice) Balancing of competing claims of other persons against an individuals claim according to some morally relevant property or merit (comparative justice)

Implications of Justice Each individual should receive what his due by right Benefits should be justly distributed among individuals Each individual should share in the burden of health and science Violations: Denying/Withholding a benefit to which a person has a right Distributing a minimum health benefit unequally Imposing an unfair burden on an individual Non-violations: Person chooses to give up what is due them Loses their right to what is due Chooses to accept an additional burden When what appears to be an unjust outcome results from a just process Distributive Justice Fairness in distributing societys benefits and burdens to its members Benefits- medical care and treatment Burdens- paying for care and partaking in experimental research

Problems: 1. Macroallocation 2. Mesoallocation 3. Microallocation Triage- medical screening of patients to determine their priority of treatment 2 principles: 1. Formal- scarce resources should not be wasted but used impartially to all whose lives are in jeopardy 2. Substantiative- establishes criteria > Utilitarian > Egalitarian Utilitarian Alternatives Represents maximizing strategies to achieve the greatest amount of good a. The medical success principle - priority to those who have the biggest chance of medical success b. The principle of immediate usefulness - greatest immediate service to the larger group under the circumstances c. The principle of conservation - those who require proportionally smaller amount of resources so more lives will be saved d. The parental role principle - to those who have largest responsibility to dependents e. The principle of general social value - those who have greatest social worth thus leading to the good of the soc Egalitarian alternatives

Represents maintaining or restoring the equality of the persons in need a. The principle of saving no one - priority to no one because not all can be saved b. The principle of medical neediness - to those with the most pressing needs c. The principle of general neediness - to the most helpless or generally neediest- the poorest candidate d. The principle of first come, first served (queuing) - first one who asks, receives e. The principle of random selection - by chance or random- lottery
Distribution of Burdens

Justice demands that giving undue burden to an individual requires his informed consent, he must understand what is involved in the burden and voluntary accept it When a person chooses, as an act of charity, to pay for another, donate an organ, subject himself to an examination or experimental procedure, JUSTICE is no longer an issue

Principle of Subsidiarity Subsidiarity stems from the demands of the virtue of Justice. It recognizes that no individual is self-sufficient. When he is unable to help himself, a stronger or higher entity in the society is called to assist him. This is well reflected in the Christian commitment to concretize Christs exhortation.

Human communities exist only to promote and share the common good among all their members from each according to ability, to each according to need in such a way that: 1. Decision making rests vertically first with the person then with the lower social levels and horizontally with the functional social levels 2. The higher social needs intervene only to supply the lower units what they cannot achieve by themselves while at the same time working to make it easier for lower units and individuals to satisfy these needs by their own efforts. Bioethics & Research Codes, Declarations, Guidelines & IRB They attempt to ensure the primacy of human being over science & society That good is achieved & harm avoided That cultural & religious differences are respected That the security, integrity, dignity & well being of human subjects are protected No double standards for developed & developing countries exist.

Norms of Research on Human Subjects Norm 1. The knowledge sought through research must be important & obtainable by no other means, & the research must be carried out by qualified people. Norm 2. Appropriate experimentation on animals & cadavers must precede human experimentation. Norm 3. The risk of suffering must be proportionate to the good to be gained - Principle of double effect Norm 4. Subjects should be selected so that risks & benefits will not fall unequally on one group in society

Norm 5. To protect personal integrity, free & informed consent must be obtained. - Proxy consent - Double-Blind Protocols Norm 6. At any time of the course of the research, the subject must be free to terminate the subjects participation in the experiment. Norm 7. In psychological experimentation, which shade imperceptibly into social research, the researcher should work with rather than on the human subject. Norm 8. The researcher must avoid breaking down human trust by lying or manipulation, although subjects can give free & informed consent to experiments in which they must learn to interpret ambiguous communications or meet puzzling situations. Norm 9. Researchers must not tale serious risks of reducing the subjects ability to perceive reality as it is or to make free choices except as a temporary experience through which the subjects can learn to cope with distortions of truth & attacks on their freedom. Stem Cell Research Embryo stem cell research Against Natural Law Against Human Dignity

Adult Stem Cell Umbilical/Placenta Stem Cell