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12/15/2017

Bioethics
l Bio “Life” / Ethics “Behavior”
l Discipline dealing with the ethical implications
of biological research and the applications of
that research

Renz Christian S. Narida R.Ph.


University of San Agustin
College of Health and Allied Medical Professions
Pharmacy Department

Ethics Morality
l Moral philosophy l principles concerning the distinction between
l Discipline concerned with what is morally right and wrong or good and bad behavior
good and bad, right and wrong l the extent to which an action is right or wrong

Emergence Some historical examples


l new scientific/technological developments in l Abortion
biomedical and life sciences. l Contraception
l Medical ethics are more concerned with the l Organ transplant, artificial ventilator, and brain
ethics of the health care professionals and death
their relationship with the patient. l In virtro fertilization (IVF)
l Cloning and stem cell research
l Genetic engineering

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Grounding Problem

Ethics
as a branch of
Philosophy

Ethical Foundations Meta-Ethics


l What is Morality? l The study of the foundations of Morality
l Whats its nature?
l Is it an Objective thing?
l Preference?
l Opinion?
l Cultural Conventions?

Ethics Moral Realism


l Is it wrong to steal for your family? l Belief that there are Moral facts in the same
l Is there a thing such as a good lie? way that there are Scientific facts

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Capital Punishment

Moral Theory Divine Command Theory

l Divine Command l One of the oldest and most widely held


ethical theory in the world
l Natural Law l The belief that Moral and Immoral is
commanded by the DIVINE
l Categorical Imperative
l Biblical Basis
l Utilitarianism l Divine rule book

l Contractarianism

l Virtue Theory

Euthyphro Problem
It addresses many of our biggest questions 1. Are right actions right because God
about right and wrong, which is why it`s the commands them?
ethical theory of choice for much of the world 2. Are right actions commanded by God
because they are right?

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Natural Law Theory


l St. Thomas Aquinas Aquinas argued that God created the world
l God has given us the tools we need to know according to natural laws:
what is good and what is bad l Predictable

l Goal-driven systems whereby

“The idea that God wants us to want good l Life is sustained , and everything
things” l functions smoothly

The Basic Good


1. Life We don’t need the Bible or religion class or
2. Reproduction church o understand the natural law
3. Educate Offspring
4. Seek God Our instinct shows us the Basic Goods and
5. Live in Society reason allows us to derive the Natural Law
from them
6. Avoid offense
7. Shun Ignorance

Prohibition and Positive


Injunction
PROHIBITION BASIC GOODS POSITIVE INJUNCTION
If God created us to seek the good and if we`re
built with the ability to recognize and seek it,
Do not kill Life Promote Life then why do people violate the Natural Law all
the time?
Don’t Prevent Reproduction Procreate
Reproduction

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The answer is…. Is-Ought Problem


l Ignorance and Emotion David Hume
l “it is fallacious to assume that just because
something is a certain way, that means that
it-ought to be that way”

l Example our Basic Goods

Categorical Imperative
Emmanuel Kant “ It doesn’t matter whether you want to be
l Use of reason Moral or not- the Moral Law is binding on all of
l Morality is constant/ Prudence
us”
l Commands one must follow regardless of
your desires, moral obligation are derived
from pure reason

The Universalizability Principle


l Act only according to that maxim which you
can at the same time will that it should
Categorical Imperative become a universal law without contradiction
Formulation
l What is the maxim of my action?

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The Formula of Humanity Utilitarianism


l Act so that you treat humanity, whether in l Jeremy Bentham and John Stuart Mill
your own person or in that another, always as l Focuses on the results or consequences of
an end and never as a mere means our actions and treats intentions as irrelevant
l Good Consequences=Good Actions
l Ends in ourselves- Ends in others
l Actions should be measured in terms of
l Moral worth of a person
happiness or pleasure that they produce

Principle of Utility
l Should batman kill the joker? l Seek Pleasure and Avoid Pain (hedonistic)
l Are you morally clean being able to kill a l Other regard
killer or are you morally dirty because of l Choose the action that will benefit the
refusing to do so? majority

Act Utilitarian Rule Utilitarian


l Good for majority l Long term

l Transplant

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Contractarianism
Thomas Hobbes “Free, rational, self-interested people realize
l Group of people  that there are more benefits to be found in
cooperating than in not cooperating”

Example Contractarianism
l Contract
a shared agreement
l Right acts are those that do not violate the
free, rational agreements that we`ve made

Implicit Contracts
l Contracts that we never actually agreed to, “Rights implies obligation, so when you take
but just sort of find ourselves in the common pot- by enjoying the goods that
the system provides- you`re expected to pay in”
Example

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Defection
Example l when you break the contract you`re in
l Prisoner whether you agreed to be in it or not and you
decide to look after your own interest instead
of cooperating

Law
l a system of rules that are created l There is no morality unless we make it up
and enforced through social or governmental
institutions to regulate behavior

Imagine a Person Who: Virtue Theory


l Always knows what to say Aristotle
l Can diffuse a tense situation l ethical that emphasizes an individual`s

l Deliver tough news gracefully character rather than following a set of rules
l Confident without being arrogant
l Brave but not reckless
l Generous but never exravagant

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Proper Functioning
“if we can focus on being good people the right l Everything has a function and the thing is
actions will follow, effortlessly” good to the extend that it fulfills its function

“become a good person and you will do good


things”

l We are animals so all that stuff that would But,


indicate proper functioning for an animal l We`re also “the rational animal” and a social
holds true for us as well animal, so our function also involves using
l We need to grow and be healthy and fertile reason and getting along with our pack

What exactly does it mean to


be virtuous?
l It means doing the RIGHT: l No need to be specific, you know what to do.
l Thing All the time
l Time l You have good judgement of right and wrong
l Way l Robust character
l Amount
l People

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Subjective
VICE VIRTUE VICE l Virtue is a skill, a way of living and that
Deficiency Golden Mean Excess something that can only be learned through
experience
l A practical wisdom
l Habituation

Moral exemplars Eudaimonia


l people who excels on how to be a virtuous l (doesn’t have a simple English translation)
person l A life well lived
l Human flourishing

Eudaimonistic Life
l A life of Eudaimonia is a life of striving. l You never done improving
It’s a life of pushing yourself to your limits and l Being best person you can be
finding success
l A Eudaimonistic life will be full of happiness
that comes from achieving something really
difficult rather than just having it handed to
you

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Essay

l Among the 6 Moral Theories, which of them


do you believe is the best foundation for
morality?
SCHOOL OF
THOUGHT

Deontology Moral Responsibility


l the theory or study of moral obligations
l acts or states of affairs for which you can be
Consequentialism praise or blamed

l Moral acts are judged by the value of its


consequences

Moral Luck
Bernard Williams & Thomas Nagel

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Ought Implies Can Moral Agents


l If you ought or should do something morally, l those who have the ability to think in terms of
then you first must be able to do it right and wrong and make decisions
l You are morally required to do things that are accordingly
possible for you
l You cant be held morally responsible for
situations that are out of your control
(Casual Responsibility)

Harm and Wrong Doing


l anything can harm you without rooting it from l External factors can affect the moral quality
wrongdoing of our actions and their effects in terms of
l some wrong doing cannot cause any harm different kinds of luck
l Difference of Murder from Homicide

Constitutive Luck Circumstantial Luck


l our own personality l Situations you find yourself in

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Justice
If ought implies can, then we should only be l Is justice about equality?
blame from the factors that we can control l About fairness?
l Getting what we deserve?
l Getting what we need?

Justice as Harmony
l A just society is one in which everyone fulfills
their roles so that society runs smoothly
l Violating your place in the social order even if
it’s a place you don’t want to hold is
considered unjust

Distributive Justice
Justice as Fairness
l Who decides who gets what and on what
basis John Rawls
Justice as Equality
l any inequalities that exist in a social system
l
l belief that everyone should get the same kind and
amount of stuff should favor the least well-off because this
l Need-based Justice levels the playing field of society
l everyone shouldn’t get the same because our needs l Need-based Justice
aren’t the same
l Merit-based Justice
l justice is giving unequally based on what each person
deserves

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Robert Nozick disagreement


Justice-is-fairness is actually unfair to those
who have gotten the most- either through hard l we cant and shouldn’t try to even out the
work, or because they happened to win life`s naturally uneven playing field
lottery l we`re each entitled to the stuff we have,
provided we didn’t steal it or obtain it unjustly

Rights implies an obligation


l Negative Rights Justice and
Punishment
l Positive Rights

Retributive Justice Welfare Maximization


l the only way for justice to be satisfied is for a l there`s no good to be found in vindictively
wrongdoer to suffer in proportion to the way causing pain to wrongdoers. But some form
he`s made other suffer of punishment is still in order
l Eye for an eye

l There is no way to right the wrong of taking a life


other than taking the life of the life taker

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1. Rehabilitation 2. Deterrence
l Give wrongdoers help so they can learn how l we punish people to send a message to other
to get along in society and follow is rules people

3. Restorative Justice
l the focus of making amends rather than on
making wrongdoer suffer

ROSS
ETHICS

● British Aristotelian
scholar and moral
philosopher
● Deontologist

however, he believes
DUTY THEORY:
that moral rules should
not be absolute or ACTUAL DUTY
inflexible vs
● He recognizes that PRIMA FACIE DUTY
there are exceptions
for every rule.

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ACTUAL DUTY PRIMA FACIE DUTY


● actual duty is one's real duty in a given ● in Latin means, “ at first view”
situation. ● is one that directs or commands what one ought
to perform when other relevant factors are not
● It is the action one ought to choose from
taken into account.
among many other actions
● “Do whichever act is more of a duty:

THE (7) PRIMA FACIE DUTIES


● The (7) Prima facie duties ● DUTY OF FIDELITY
● Duty of Fidelity ● We should be faithful to our duties, obligations,
● Duty of Reparation vows, or pledges

● Duty of Gratitude ● DUTY OF REPARATION


● Duty of Justice ● Duty of Compensation

● Duty of Beneficence ● We have a duty to make amends for injury that


we have inflicted on others
● Duty of Self-improvement
● Do good to make up for the damage done
● Duty of Nonmaleficence

THE (7) PRIMA FACIE DUTIES THE (7) PRIMA FACIE DUTIES
● DUTY OF GRATITUDE ● DUTY OF BENEFICENCE
● We have a duty to appreciate & recognize the ● This duty enjoins us not only to bring about what
service others have done for us. is good for others but also to help them better
their conditions.
● DUTY OF JUSTICE
● This duty demands fairness for everyone . ● This duty requires the provision of benefits and
balancing of benefits and harm.

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THE (7) PRIMA FACIE DUTIES THE (7) PRIMA FACIE DUTIES
● DUTY OF SELF-IMPROVEMENT ● DUTY OF NONMALEFICENCE
● We have a duty to improve and develop ● This duty is synonymous to “not injuring others”
ourselves with respect to virtue, intelligence, ● We ought to avoid inflicting evil, injury, or harm
and happiness. upon others as we would avoid doing so to
● Having done my duty of self-improvement – ourselves.
morally, intellectually, and physically – I would
be in a better position to fulfill my duties to
others

RATIONALE OF ROSS'S ETHICS RATIONALE OF ROSS'S ETHICS


● Ross's ethics encourages us to show discernment ● His (7) prima facie duties prompts healthcare
and sensitivity with regard to the unique aspects of professionals responsible for patient care and to reflect on
varying conditions before making a moral decision. these duties and to choose the one that best applies to a
situation.

● Our moral guide should be not what is useful, but


● Not only must we consider, the possible consequences of
what is right. our moral decisions, but we must also recognize the
duties that would justify our moral actions.

The Basic Ethical


Principles
l Stewardship
l Totality

Ethical l Double Effect

l Cooperation

Principles
l Solidarity

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Principle of
Stewardship Principle of Totality
l Steward/stewardess – one appointed l Totality – wholeness, completeness
l Stewardship l Principle
l concomitant values/virtues of responsibility and l any entity that is made up of parts that together
accountability constitutes as a whole
l HC professionals are stewards in the health l but the whole is greater than any of its parts
care service

Principle of Double Principle of Double


Effect Effect
l It distinguishes performance of good act that has
l It contemplates on:
BOTH good and evil effects, from performance of evil
l Two effects or outcomes arising from the act so that good effect may result from there from
performance of an action
l Conditions
l 1st effect : Results from agent’s intent, desire,
1. Action done or chosen must be morally good, or at least
wish, will indifferent or neutral
l 2nd effect : is only allowed, tolerated or permitted 2. Good effect must come from action itself, not from or
following as a consequence of secondary evil effect
3. Good effect is what is intended, evil effect is just tolerated
or allowed with sufficient reason
4. Good effect must outweigh or be equal to evil effect

Principle of
Cooperation Principle of Solidarity
l It implies: l It implies
l One works with others in the l Unity or fellowship, arising from common
performance of an act to accomplish a responsibility and interest
goal l One for all, all for one
l Outcome:
l Good: promotes the well being of clients
l Evil: participants can be
§ Principals by indispensable cooperation
§ Accomplice who cooperated to the act

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Health Care
Profession
l Anoccupation requiring
advanced, specialized and
systematic study and training in
the knowledge of Health care
designed to provide services to
society in the particular field.

Health Care Practice Basic Qualities of a


l Best of Science
Health Care Practitioners
l Noblest of Human Acts l Self knowledge & self acceptance
l A career that never stops growing (an l Pure & clear Motivations
evolving practice) l Strong will & determination
l Challenging

l Criteria of a Profession:
l Self regulating

Basic Attitudes of a Health Care Professional


Relationship
Health Care Practitioners
l Therapeutic Relationship
l Caring & warm l HC Practitioner – Patient
l Comforting l Intellectual, Moral & Clinical Wisdom

l Courteous
l Collaborative Relationship
l Affirming, Accepting & Loving
l HC Practitioner - HC Practitioner
l Propensity for continuous learning

l Empathetic presence

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Basic Unethical & Basic Unethical &


Unprofessional Practices Unprofessional Practices
1. Sizing up one’s professional capacity
5. Embarrassing a colleague or
before others
subordinate before a client or patient
2. Maligning the credibility & reputation of
6. Breaking the rules of confidentiality and
a member of the team or of the same
seal of secrecy
professional group to clients or others
7. Transgressing professional Code of
3. Performing actions beyond one’s
Ethics governing conduct of HC
professional functions and capacity
Practitioner
4. Having illicit & sexual relationship with a
client

Basic Unethical &


Unprofessional Practices Malpractice
8. Denying delivery of health care services
on the basis of the patients inability to l Injurious or unprofessional treatment or
pay whose case is a matter of life and culpable neglect of a patient by a physician
death or other practitioner
9. Engaging in fraudulent acts l The performance or result go against what

unbecoming of a professional ought to be expected from a HC practitioner.


l It fails to exhibit knowledge, skills & efficiency
10. Fabricating patient’s record and
medical certificates for any purposes. ** Natural Law : do good, avoid evil

General Conditions for Validity for


Negligence Claim for Medical Malpractice
l Failure to use a reasonable amount of care
when such failures result in injury or damage 1. Duty
to another There is an existing HC practitioner – Patient
l Being not careful relationship
2. Duty was Breached
Gross Negligence Practitioner did not conform with standard of care.
there was Negligence.
l Blatantly wrong conduct involving intense
vincible ignorance insufficient or 3. Causation
misappropriated skills and wrong judgement in The breach of duty was a proximate cause of the injury
the practice of a profession resulting to great 4. Proof
harm or damage.
Damage was caused by breach of duty
l Being seriously careless

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Becoming a Prerequisites

PHARMACIST l At least 21 years of age


l Passed the corresponding
examination given by the board of
Pharmacy
l A holder of a valid certificate of
registration duly issued to him by the
said Board

Candidacy for Board


Examination Pharmacy
l Citizen of the Philippines
l The art and science of preparing and
l Of good moral character dispensing medication and the provision of
l Graduated BS Pharmacy (NLT 4 drug related information to the public
years)
l Completed an internship program of at
least 960 hours
l 480 hours : Major
l 160 hours : Community
l 160 hours : Hospital
l 160 hours : Manufacturing

A Pharmacist A Pharmacist
l Prepare or manufacture, analyze,
l A person shall be deemed to be practicing assay, preserve, store, distribute or
pharmacy who shall, for fee, salary, sell any medicine, drug chemicals,
percentage or other reward paid or given cosmetics, pharmaceuticals,
directly to him or indirectly through another: devices of contrivances used in
pursuance thereof; or

• Render pharmaceutical service in any office


or drug and cosmetic establishment where
scientific, technological or professional
knowledge of pharmacy is applied; or

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A Pharmacist
l Engage in teaching scientific,
technological or professional pharmacy
subject in a college of pharmacy; or
l Conduct or undertake scientific
pharmaceutical research for biological
and bacteriological testings and
examinations.
Laws Governing the
Practice of Pharmacy

RA 3720 (Foods, Drugs, and


RA 5921 (The Pharmacy Law) Devices and Cosmetics Act)
l Govern the standardization and l Establish standards and quality measures for
regulation of pharmaceutical foods, drugs, and cosmetics.
education l Adopt measures to ensure pure and safe supply
of foods and cosmetics, pure safe and
l Examinations for registrations of
efficacious and good quality drugs and devices
graduates of schools of pharmacy in the country
l Supervision, control, and regulation of l Strengthen the Food Drug Administration
the practice of pharmacy in the
Philippines

RA 9257
RA 6675 (Generics Act of 1988)
(Expanded Senior Citizen Act of
l To promote, encouage, and require the use 2003)
of generic terminology in the importation,
manufacture, distribution, marketing, RA 8203
advertising and promotion, prescription, and (Special Law on Counterfeit
dispensing.
Drugs
l Others
To ensure supply of drugs at lowest cost,
l
minimize duplication in medications
RA 9165
(The Comprehensive Dangerous
Act of 2002

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RA 8423
(Traditional and Alternative The 10 Star Pharmacist
Medicine act of 1997 )
RA 7394
(Consumers Act of the
Philippines)
RA 7581
(Price Act)

Code of Ethics of Pharmacists Code of Ethics of Pharmacists


1. A pharmacist places the well being of the 4. A pharmacist respects the right of patient
patient at the center of professional and uphold confidentiality of patient
practice records
2. A pharmacist promotes welfare of each 5. A pharmacist acts with honesty, integrity
and professionalism in relationship with
individual in a caring and compassionate
the patient and other health professionals
manner
6. A pharmacist respects the abilities,
3. A pharmacist serves the need of the values and contributions of colleagues
individual, community and society and and other health care professional and
provides health for all. work with them closely to ensure better
health care

Code of Ethics of Pharmacists Essay


7. A pharmacist is committed to l A Pharmacist did not dispense a medication
continuously enhance professional because the patient is his enemy
competence l A pharmacist pushed a drug less safe than the
other medication for profit
8. A pharmacist, in coordination with the l A pharmacist corrected a nurse’s error in front of
government and other health the family of the patient
professionals help in the formulation and l A pharmacist refused to attend seminars
implementation of health care policies,
standards and programs designed for the l What will happen to our profession if these
benefit of society violations will continue??

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END

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