Bioethics - the Ultimate Expression of Values

In loving memory of my son, Vicente Paolo 
Dr Abe V Rotor

Paolo drew one, last deep breath and held it there as if forever. His eyes were

wide open, glassy and welled with tears. His pale lips went agape as his whole body tensed. That was the arrival of the inevitable moment when he gave up fighting for life.

  Paolo   

Immediately, doctors, working with quick hands put the boy’s body under the command of modern machines like: a high voltage cardiac resuscitator; a lung machine that works on the principle of our diaphragm; and electronic gadgets to monitor pulse rate, body temperature and blood pressure. The sight of wires and tubes all over the young patient, with doctors working double time, reminds one of the desperate, but futile, effort to save the mortally wounded President of the United States, John F. Kennedy, in a Dallas hospital on November 22, 1963.

      This situation also reminds one of the celebrated Karen Quinlan case. This is about a young woman, who remained in a state of coma at a US hospital for more than a year.  Since her condition was not improving, she was unplugged from her life-sustaining machines. The case became an issue of a long court battle.  In the end, the patient was allowed to die, unplugged from her machines. 

      The court’s decision leaned heavily on the principles of bioethics. These principles continue to influence similar cases today, some 30 years later. Bioethics, the ethics of the life sciences, offers guidelines for dealing with life-and-death decisions. The ethical principles involved are expressions of values, and the humane foundations of moral values.

      In both the cases of Paolo and Karen, we ask? What is clinical death? Is the prolongation of life with machines (despite certification of a hopeless condition), justifiable?  In short, is keeping people alive through artificial means ethical? 

      By analyzing the interrelationships of ethical principles, we conclude that the human being must be respected. Allow him to die peacefully and let the bereaved family realize God’s sovereignty over life and all creation.

Bioethics and Social Justice

      Outside the hospital, people needing immediate treatment, are waiting for their turn.  There are those, mostly poor, who have been waiting silently in prolonged agony. In remote towns and villages, it is considered a luxury to have a doctor around. The medical care most poor people know are unreliable, often associated with superstitious beliefs. What an extreme scenario from that of Paolo and Karen!

      Thus bioethics and social justice must go hand in hand as we view its application upon the millions of poor people who are dying without benefit of good medicine. Like in war, precious medicine is applied on the potentially salvageable, and denied for those who are dead or beyond help.

      Yet there are those who feel privileged with “over treatment”. This is why we question the morality of cryogenics (dealing with the effects of very low temperatures), its lavishness and futuristic goals.  There are over a hundred rich people in America today whose bodies lie in cryogenic tanks, awaiting the day when medicine shall have found a way to revive them.

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      “In the real sense, the practice of virtue is what morality is all about, meaning lived morality, the morality that leads to self-realization and ultimately, happiness.  After all, virtue is the road to happiness.”

                            

   Fr. Fausto Gomez, OP, STD, Relevant Principles in Bioethics

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      Here is another example of social injustice. The US spends US$1.5 billion daily on healthcare, even as more than a quarter of its population are deprived of medical benefit. One can imagine the tremendous contribution to world peace and improvement in the quality of human life, if only a portion of this wealth and that used for resurrecting life is diverted to the plight of the world’s poor.

Bioethics and Disease Prevention

      Dr. Mita Pardo de Tavera is a doctor who believes in the primary health care approach of involving people’s full participation. She raised ethics of  appropriability disease prevention as superior to its cure. This approach should be part of a program to eradicate diseases such as tuberculosis. The solution is not to be dependent merely on medical approaches, but on sound socio-economic programs as well that deal with illiteracy and unemployment. 

Pillars of Bioethics

      The broad domain of bioethics rests on four pillars, as follows:

§  Truth

§  Compassion

§  Beneficence

§  Justice

      Goodness springs from every righteous person when dealing with questions on bioethics.  It is conscience, that inner voice which makes us conscious of guilt.

      But how good is good enough?  To answer this question, we have to qualify conscience as formative conscience.  Fr. Tamerlane Lana OP STD, rector of the University of Santo Tomas, emphasizes that the formation of conscience is a life-long task, especially for professionals whose decisions directly affect the lives of people. The goal is for them to attain a well-informed conscience, which is upright and truthful, and that does not rely merely on acquired knowledge. It has to be a conscience guided by the spiritual nature of man.

Growing Application of Bioethics

      Today, with man’s growing affluence we find bioethics as part of the expanding fields of science and technology, areas that have direct consequences affecting human life.  Thus, we hear people raising questions of morality and ethics in various areas such as:

§  Euthanasia.

§  Hospice management.

§  Organ transplantation and rehabilitation.

§  Contraception, abortion and sterilization.

§  Social justice in the allocation of healthcare resources.

§  The Human Genome Project (HGP), and genome mapping.

§  Genetic engineering and human cloning.

§  In vitro fertilization (test tube babies).

§  Surrogate motherhood.

§  Menopausal childbirth technology.

§  Induced multiple births.

§  Aging and extension of longevity.

§  Pollution and global warming.

§  Ecosystems destruction.

§  Thermonuclear, biological and chemical warfare.

      These areas of concern in bioethics are expanded into medical ethics for doctors, lawyers and scientists to know. These include the following cases: 

1.     Food Additives and Contamination.

      Vital issues of discussion are the manufacture and distribution of food laced with harmful substances like potassium bromide in bread, sulfite in white sugar, nitrate in meat, glacial acetic acid in vinegar, monosodium glutamate (MSG) in cooked food, and aspartame in softdrinks.  Many of these substances are linked to cancer, diabetes and loss of memory.

2.     Ecological Bioethics.

      “Is it a sin to cut a tree?” a student asked this author.

      This is a bioethical question. It is not the cutting of the tree, per se, that causes the “sin”. Rather, it is the destruction of the ecosystem, the disruption of the functioning of natural laws resulting from the tree cutting, that is considered unethical.  

      The unabated logging of the watersheds of the once beautiful city by the sea – Ormoc City in Southern Leyte -  caused massive mudflows sweeping the central part of the community and killing hundreds of residents. Yet the ethics and morality of the actions of the loggers were never questioned.

       In the realm of theological sciences, this tragedy is akin to the paradigm of salvation.  According of Fr. Percy Bacani CICM, it is a sin to harm the environment, because it causes people to suffer. To find salvation, the culprits of the Ormoc tragedy should plow back their ill-gotten wealth for rebuilding the community they destroyed. The morality of this paradigm touches deep down at the roots of moral philosophy.

Five Principle in Bioethics

      Basic questions are raised where bioethics and moral philosophy are involved. These questions may be categorized under five general types.

§  When are we responsible for the consequences of our actions? (Principle of indirect voluntary).

§  How far may we participate in the performance of evil actions done by others? (Principle of cooperation).

§  When may we ethically perform an action from which results in two effects, good and evil? (Principle of double effect).

§  Are we the lords of our lives and all creation, or only custodians thereof? (Principle of stewardship).

§  Is the good of a part subordinated to the good of the whole? (Principle of totality).

      These general ethical principles serve as guides in analyzing situations, making decisions, or forecasting the consequences of one’s actions. These principles are used in law, philosophy, theology, management and other disciplines. The values on which they are founded which, in turn, provide the virtues that guide our actions, remain unchanged.

      Why do we not always follow the dictates of our conscience? “It is because we are weak, or blinded by sin or vice. Or because we lack virtue and fortitude,” says Fr. Fausto Gomez OP, regent and professor of bioethics at the UST College of Medicine.

      Man has yet to learn to avoid evil, and to do good.  Temptation leads one to sin, but so does complacency and inaction.

      On that fateful day, Paolo my hero, was the focus of a most crucial decision the doctors, my family and I had to make. When we made it, the life-sustaining machines were finally removed that day in 1983. Paolo died in my arms. He was my son. ~  
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A doctor is a man who writes prescriptions till the patient either dies or is cured by nature. — William Broome

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Young fronds of coconut are offered on Palm Sunday. Thousands of coconut seedlings and trees are sacrificed, leading to the death of thousands of trees on a single occasion every year. Estimated loss runs to millions of pesos. The productive life of a coconut may extend to fifty years.  

The value of nuts and other products (tuba, midrib, husk, leaves, firewood, charcoal) produced by a single tree in a year is between P1000 to P5000. The same occasion endangers other species such as buri, anahaw, and oliva or cycad which are living fossils, and are now endangered species.  


Food additives like MSG (monosodium glutamate), artificial sugars (aspartame, nutrasweet, saccharin and other brands) destroy human health, in fact cause premature aging and early death.  

Intensive monocropping depletes soil fertility, and destroys physical properties, such as tilth, water retention, organic matter content, which are necessary to good production and sustainable productivity.~

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"When we see land as a community to which we belong, we may begin to use it with love and respect…. That land is a community is the basic concept of ecology, but that land is to be loved and respected is an extension of ethics." -  Aldo Leopold (1949)