BIOETHICS

JAIME Q. BALMORES September 16, 2006

BIOETHICS
Bioethics concerns the ethical questions that arise in the relationships between biology, medicine, cybernetics, politics, law, philosophy, and theology. Disagreement exists about the proper scope for the application of ethical evaluation to questions involving biology. Some bioethicists would narrow ethical evaluation only to the morality of medical treatments or technological innovations, and the timing of medical treatment of humans. Other bioethicists would broaden the scope of ethical evaluation to include the morality of all actions that might help or harm organisms capable of feeling fear and pain.

BIOETHICS
Bioethics is integral to nursing care Serves as the basis for decision making in simple and complex clinical situations. Ethical decision making serves as the basis for respecting patients wishes/decisions, especially when the patient is not able to actively participate in the decision making process. By utilizing the symphonological approach as a guide to the contextual application of the bioethical standards, the nurse is able to act with or for patients, and protect her/his own integrity.

EUTHANASIA
Euthanasia (from Greek: , eu, "good", thanatos, "death") is the practice of terminating the life of a person or an animal because they are perceived as living an intolerable life, in a painless or minimally painful way either by lethal injection, drug overdose, or by the withdrawal of life support. Euthanasia is a controversial issue because of conflicting religious and humanist views.

EUTHANASIA
Debate exists as how to precisely define euthanasia. According to the narrow definition only acts of killing, where a definite action is taken to end the patient's life, constitutes euthanasia. In a more broad definition, both direct killing and allowing a patient to die, where the steps needed to preserve a life are simply not taken, would constitute euthanasia. The moral importance of this distinction is that if one uses the narrow distinction, allowing someone to die does not constitute euthanasia and one may argue that all acts of euthanasia are inherently wrong

EUTHANASIA
Active euthanasia refers to a physician painlessly putting to death some persons suffering from incurable conditions or diseases. Passive euthanasia, in contrast, refers to any act of allowing the patient to die, which may include failing to provide necessary medication as well as taking a patient off life support. Both active and passive euthanasia can be voluntary, non-voluntary or involuntary.

EUTHANASIA
Physician assisted suicide is where doctors assist terminally ill patients in taking their own life. This is often seen as morally distinct from euthanasia because the physician does not directly cause the patient's death but enables the patient to choose the time and circumstances of his or her own death.

EUTHANASIA
Voluntary euthanasia occurs with the fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). (Example: Thomas Youk with ALS was assisted by Jack Kevorkian.) This should not be confused with death after treatment is stopped on the instructions of the patient himself, either directly or through a do not resuscitate (DNR) order. Enforcing a DNR order has never been considered assisted suicide or suicide of any kind, at least in the eyes of the law. Patients of sound mind have always had a right to refuse treatment.

EUTHANASIA
Nonvoluntary euthanasia occurs without the fully-informed consent and fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). An example of this might be if a "patient" has decisional capacity but is not told they will be euthanized; or, if a patient is not conscious or lacks decisional-capacity and their surrogate is not told the patient will be euthanized.

EUTHANASIA
Involuntary euthanasia occurs over the objection of a patient or their surrogate (proxy). An example of this might be if a patient with decisional capacity (or their surrogate) is told what will happen. The patient (or surrogate) refuses yet the patient is euthanized anyway. This is generally considered murder. If a patient slated for euthanasia changes his or her mind at the last minute, the doctor is categorically required by law to honor that wish. In most other countries removing or denying treatment without the clear instructions of the patient is usually seen as murder.

EUTHANASIA
Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment, with the exception of medication for symptom control (such as analgesia). It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.

EUTHANASIA
Animal euthanasia is commonly referred to by the euphemism "put to sleep Mercy Killing is a term used for some cases of euthanasia. Typically it refers to euthanasia by a someone other than a doctor, such as a parent, who perceives the individual to be suffering. In some cases the individual cannot consent. In some cases the individual can consent but is not asked or refuses. Lastly, in some cases the individual consents, and it may even be them who initiates the discussion

EUTHANASIA
The law permits euthanasia and physician assisted dying when each of the following conditions is fulfilled: the patient's suffering is unbearable with no prospect of improvement the patient's request for euthanasia must be voluntary and persist over time (the request can not be granted when under the influence of others, psychological illness or drugs) the patient must be fully aware of his/her condition, prospects and options there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above the death must be carried out in a medically appropriate fashion by the doctor or patient, in which case the doctor must be present. the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)

EUTHANASIA MACHINE
A machine that can facilitate Euthanasia through heavy doses of drugs. Among chronically depressed or ill "users", this can be construed as a relief. It is possible in this image to see the laptop screen that leads the user through a series of steps and questions, to the final injection, which is done by motors controlled by the computer. This series of questions is supposedly to prevent unprepared users from

EUTHANASIA
Euthanasia can be accomplished either through an oral, intravenous, or intramuscular administration of drugs. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred.

EUTHANASIA
The following is a Dutch protocol for parenteral (intravenous) administration to obtain euthanasia: Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium (Nesdonal) in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium dibromide (Pavulon) or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium dibromide (Pavulon) are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg.

DO NOT RESUSCITATE (DNR)

In PHC. OBJECTIVES for DNR orders: To ensure that all orders for DNR are made only after careful medical and ethical processess are made To ensure proper education of all Medical Personnel and all those involved in the care of the terminally ill or dying patient in matters concerning medical, legal and ethico-moral aspects

DO NOT RESUSCITATE (DNR)

OBJECTIVES for DNR orders: To assist patient or family in their decision when medical facility is present.

INDICATIONS FOR DNR ORDERS

The condition or disease of the patient is terminal and death is imminent. The patient is irreversibly comatose and there is no reasonable hope for recovery or improvement. The burden of treatment far outweighs the expected benefits.

SOME GUIDELINES ON DNR ORDERS

The decision not to resuscitate a patient must be arrived at only after thorough evaluation of the patients medical status and prognosis and with consultation, if necessary, with various medical authorities and specialists concerned. The attending physician is responsible for adequately explaining the nature and the prognosis of the illness to the patient or his nearest of kin in cases of incompetence and the consequences of not instituting resuscitation efforts including withdrawal and withholding extraordinary life support equipment to the patient. The order of DNR is made by the attending physician and should be legibly written in the patients record in his own handwriting and with justification why the

SOME GUIDELINES ON DNR ORDERS

The DNR order is a consensual decision of the physician and the competent patient or his nearest kin in case of incompetence in the following order: spouse, children of legal age, parent or parents, siblings, or legally appointed guardians. If the medical condition of the patient improves, the DNR order must be revoked immediately and must be transmitted to all the members of the team and nursing staff.

ABORTION
An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in, or caused by, its death. This can occur spontaneously as a miscarriage, or be artificially induced through chemical, surgical or other means. Commonly, "abortion" refers to an induced procedure at any point in the pregnancy; medically, it is defined as a miscarriage or induced termination before twenty weeks gestation, which is considered nonviable. There have been various methods of inducing abortion throughout history. The moral and legal aspects of abortion are the subject of intense debate in many parts of the world.

ABORTION
Spontaneous abortion (miscarriage): An abortion due to accidental trauma or natural causes, such as a chromosomal number discrepancy, early disease, or environmental factors. Induced abortion: An abortion deliberately caused. Induced abortions are further subcategorized into therapeutic abortions and elective abortions: Therapeutic abortion: To save the life of the pregnant woman. To preserve the woman's physical or mental health. To terminate a pregnancy that would result in a child born with a congenital disorder which would be fatal or associated with significant morbidity. To selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.

ABORTION
Elective abortion: An abortion performed for any other reason. A pregnancy that ends earlier than 37 complete weeks of gestation, and where an infant is born and survives, is termed a premature birth. A pregnancy that ends with an infant dead upon birth at any gestational stage, due to causes including spontaneous abortion or complications during delivery, is termed a stillbirth. In common parlance, the term "abortion" is synonymous with induced abortion of a human fetus. However, in medical texts, the word 'abortion' can also refer to spontaneous abortion (miscarriage). The distinctions between spontaneous abortion, therapeutic abortion and induced delivery may be blurred. For example, in cases of pre-eclampsia spontaneous abortion may occur, but if it does not, doctors may opt for immediate delivery regardless of the potential viability of the fetus.

Social issues on ABORTION

A number of complex issues exist in the debate over abortion. These are a focus of research and a fixture of discussion among members on all sides the controversy.

Effect upon crime rate

A controversial theory attempts to draw a correlation between the unprecedented nationwide decline of the overall crime rate witnessed in the United States during the 1990s and the decriminalization of abortion 20 years prior. They attributed the drop in crime to a reduction in individuals said to have a higher statistical probability of committing crimes: unwanted children, especially those born to mothers who are African-American, impoverished, adolescent, uneducated, and single. The change coincided with what would have been the adolescence, or peak years of potential criminality, of those who had not been born as a result of Roe v. Wade and similar cases. Donohue and Levitt's study also noted that states which legalized abortion before the rest of the nation experienced the lowering crime rate pattern earlier and that those with higher abortion rates had more pronounced reductions.

Sex-selective abortion
The advent of both ultrasound and amniocentesis has allowed parents to determine sex before birth. This has led to the occurrence of sex-selective abortion or the targeted termination of a fetus based upon its sex. It is suggested that sex-selective abortion might be partially responsible for the noticeable disparities between the birth rates of male and female children in some places. The preference for male children is reported in many areas of Asia, and the use of abortion to limit female births has been reported in Mainland China, Taiwan, South Korea, and India.

Sex-selective abortion
In India, the economic role of men, the costs associated with dowries, and a Hindu tradition which dictates that funeral rites must be performed by a male relative have led to a cultural preference for sons. The widespread availability of diagnostic testing, during the 1970s and '80s, lead to advertisements for services which read, "Invest 500 rupees [for a sex test] now, save 50,000 rupees [for a dowry] later." In 1991, the male-to-female sex ratio in India was skewed from its biological norm of 105 to 100, to an average of 108 to 100. Researchers have asserted that between 1985 and 2005 as many as 10 million female fetuses may have been selectively aborted. The Indian government passed an official ban of pre-natal sex screening in 1994 and moved to pass a complete ban of sexselective abortion in 2002.

Sex-selective abortion
In the People's Republic of China, there is also an historic son preference. The implementation of the one-child policy in 1979, in response to population concerns, led to an increased disparity in the sex ratio as parents attempted to circumvent the law through sex-selective abortion or the abandonment of unwanted daughters. Sex-selective abortion might be a part of what is behind the shift from the baseline male-to-female birth rate to an elevated national rate of 117:100 reported in 2002. The trend was more pronounced in rural regions: as high as 130:100 in Guangdong and 135:100 in Hainan. A ban upon the practice of sex-selective abortion was enacted in 2003.

Unsafe abortion
Where and when access to safe abortion has been barred, due to explicit sanctions or general unavailability, women seeking to terminate their pregnancies have sometimes resorted to unsafe methods.

Unsafe abortion
Back-alley abortion" is a slang term for any abortion not practiced under generally accepted standards of sanitation and professionalism. The World Health Organization defines an unsafe abortion as being, "a procedure...carried out by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. This can include a person without medical training, a professional health provider operating in substandard conditions, or the woman herself.

Unsafe abortion
Unsafe abortion remains a public health concern today due to the higher incidence and severity of its associated complications, such as incomplete abortion, sepsis, hemorrhage, and damage to internal organs. Complications of unsafe abortion are said to account, globally, for approximately 13% of all maternal mortalities, with regional estimates including 12% in Asia, 25% in Latin America, and 13% in sub-Saharan Africa. Health education, access to family planning, and improvements in health care during and after abortion have been proposed to address this phenomenon.

Abortion debate
Over the course of the history of abortion, induced abortion has been the source of considerable debate, controversy, and activism. An individual's position on the complex ethical, moral, philosophical, biological, and legal issues is often related to his or her value system Opinions of abortion may be best described as being a combination of beliefs on its morality, and beliefs on the responsibility, ethical scope, and proper extent of governmental authorities in public policy. Religious ethics also has an influence upon both personal opinion and the greater debate over abortion

Abortion debate
Abortion debates, especially pertaining to abortion laws, are often spearheaded by advocacy groups belonging to one of two camps. Most often those in favor of legal prohibition of abortion describe themselves as pro-life while those against legal restrictions on abortion describe themselves as pro-choice. Both are used to indicate the central principles in arguments for and against abortion: "Is the fetus a human being with a fundamental right to life?" for pro-life advocates, and, for those who are pro-choice, "Does a woman have the right to choose whether or not to have an abortion?"

Abortion debate
In both public and private debate, arguments presented in favor of or against abortion focus on either the moral permissibility of an induced abortion, or justification of laws permitting or restricting abortion. Arguments on morality and legality tend to collide and combine, complicating the issue at hand. Debate also focuses on whether the pregnant woman should have to notify and/or have the consent of others in distinct cases: a minor her parents; a legally-married or common-law wife her husband; or a pregnant woman the biological father. In a 2003 Gallup poll in the United States, 72% of respondents were in favor of spousal notification, with 26% opposed; of those polled, 79% of males and 67% of females responded in favor.

Abortion law
Before the scientific discovery that human development began at fertilization, British common law allowed abortions to be performed before quickening, the earliest perception of fetal movement by a woman during the second trimester of pregnancy. In 1861, the British Parliament passed the Offences Against the Person Act, which outlawed abortion throughout the British Empire. The Soviet Union, with legislation in 1920, and Iceland with legislation in 1935 were some of the first countries to generally allow abortion. The second half of the 20th century saw the liberalization of abortion laws in other countries. The Abortion Act 1967 allowed abortion for limited reasons in the United Kingdom

Abortion law
In the 1973 case, Roe v. Wade, the United States Supreme Court struck down state laws banning abortion in the first trimester, ruling that such laws violated an implied right to privacy in the United States Constitution. The Supreme Court of Canada, similarly, in the case of R. v. Morgentaler, discarded its criminal code regarding abortion in 1988, after ruling that such restrictions violated the security of person guaranteed to women under the Canadian Charter of Rights and Freedoms Canada later struck down provincial regulations of abortion in the case of R. v. Morgentaler (1993). Abortion in Ireland, on the other hand has been affected by the addition of an amendment to its Constitution in 1983 by popular referendum, recognizing "the right to life of the unborn".

Abortion law
Current laws pertaining to abortion are diverse. Religious, moral, and cultural sensibilities continue to influence abortion laws throughout the world. The right to life, the right to liberty, and the right to security of person are major issues of human rights that are sometimes used as justification for the existence or the absence of laws controlling abortion. Many countries in which abortion is legal require that certain criteria be met in order for an abortion to be obtained, often, but not always, using a trimester-based system to regulate the window in which abortion is still legal to perform

Abortion law
In the United States, some states impose a 24-hour waiting period before the procedure, prescribe the distribution of information on fetal development, or require that parents be contacted if their minor daughter requests an abortion. In the United Kingdom, as in some other countries, two doctors must first certify that an abortion is medically or socially necessary before it can be performed.

Abortion law
Other countries, in which abortion is illegal, will allow one to be performed in the case of rape, incest, or danger to the pregnant woman's life or health. A handful of nations ban abortion entirely, such as Chile, El Salvador, and Malta, although Chilean government freely distributes the "morning-after" pill. In Bangladesh--although abortion is illegal-- the government has long supported a network of "menstrual regulation clinics," where menstrual extraction (manual vacuum aspiration) can be performed as menstrual hygiene.

In conclusion.
Because of our weakened nature, death will never be something that we welcome. But through grace, we can accept it as the way to union with GOD. As we view the health care scene in our country, one is struck by denial of death. In order to overcome the fear of death and help oneself as well as other people will die, one must learn to overcome the emotional strain that accompanies suffering and death and deal with the ethical issues often encountered.

In conclusion.
To communicate to patients effectively the meaning and power of death, health care professionals must have some experience of its reality themselves. Thus, health care is more than a job, more than knowledge and technique. Basically, in its fullness it is a way of life that sees beyond the hurt, the sickness, the anguish.

In conclusion.
A way of life that enables one to look beyond the drudgery of daily reality, beyond the suffering in the hospital ward and the emergency room. A way of life that centers in Gods love for his children, the suffering of Christ for all human beings and his victorious resurrection.

Human life is sacred.

Life should not be violated nor destroyed but must be respected, protected and preserved. It is primary moral obligation of all those who are responsible for the health of the patient to show respect for