Abortifacient:
1) Any device or drug that, used after
fertilization*, could destroy the developing prenatal child, prevent implantation or
cause the expulsion of the developing prenatal child.
2) Any device or drug that, used after implantation, could destroy the
developing prenatal child or cause its expulsion.
Application:
1) Low dose birth control pills and drugs marketed as 'morning after
pills' or 'emergency contraception' are abortifacients if they act by preventing
implantation. PCL's that protect refusal to participate in abortion apply in this
case.
2) Laws that protect conscientious objection to abortion* do not
protect refusal to prescribe or dispense drugs that prevent implantation.
Note: the meaning of 'abortifacient'
in a medical or scientific context is not the same as its meaning in a
moral context. In a medical context, a drug that prevents fertilization
(acts contraceptively) 95 to 99 times out of a hundred would be called a
contraceptive rather than a abortifacient. But in a moral context, when
the outcome may be death, a drug may be treated as an abortifacient if
there is even a 1% chance of it killing the embryo by preventing
implantation.
Abortion (spontaneous/natural;
miscarriage):
1) Expulsion of the developing prenatal
child from fertilization*to about the twenty eighth week of gestation.
Delivery from the 28th week is considered a premature birth.
2) Expulsion of the developing prenatal child from implantation (5-7 days
gestation) to about the twenty eighth week. Delivery from the 28th week is
considered a premature birth.
Abortion
(induced):
1) Deliberately induced expulsion or extraction of the developing prenatal child from
fertilization* until the point of birth, for the purpose of causing its death.
Technical terms denote abortions accomplished using specific techniques
(suction, saline, prostaglandin, partial birth, etc.).
2) Deliberately induced expulsion or extraction of the developing prenatal child
from implantation (5-7 days gestation) until the point of birth, for the purpose of
causing its death. In addition to the technical terms noted above, induced abortions
are also called terminations of pregnancy, genetic terminations, genetic inductions.
Application:
1) Any drug or device that prevents implantation of the early embryo* is an
abortifacient*, not a contraceptive*.
2) Devices or drugs that prevent implantation of a 'fertilized egg'*
are emergency contraceptives', not abortifacients*.
Beneficence:
1) A principle of medical ethics
requiring that one treat and care according to what is good for an individual patient, and
a) What is 'good' must accord with
the nature* of a human being.
b) What is 'good' need not accord with a particular
concept of the nature* of a human being.
2) A principle of medical ethics requiring
that one treat and care according to what is good for others, and
a) What is 'good' for others must
include what is 'good' in the sense of 1a.
b) What is good for others need not include what is 'good'
in the sense of 1a.
3) A principle of bioethics (principlism) in which what is
"beneficent" or "good" is what is "good" for society
(rather than the traditional Hippocratic Oath understanding of "good" for
the individual patient).
Application
1,2a) Withdrawal of ordinary medical treatment* is not good for
the patient and contradicts the principle of beneficence.
2b-3) Withdrawal of ordinary medical treatment* that results
in significant savings to the community, even at the expense of the patient, does not
contradict the principle of beneficence.
Benefit:
1) A good for the individual patient,
that
a) accords with the nature*
of a human being
b) need not accord with the nature* of a human being
2) A good for others that
a) Must include what is
good for the individual patient in the sense of 1a.
b) Need not include what is good for the individual patient in the sense of 1a.
Application
1a) Life is always a benefit. Deliberate killing is not beneficial.
1b)
Life may not be a benefit. Deliberate killing may be
beneficial.
2a) Life is always a benefit. Deliberate killing is not beneficial.
2b) Life may not be a benefit. Deliberate killing may be
beneficial.
Bioethics (secular bioethics)
A relatively new term.
It was institutionalized by the Belmont Report (U.S. Dept. of Health , Education and
Welfare, 1979). Before that people spoke of "medical ethics".
Medical ethics and bioethics operate from different moral principles and come
to different moral conclusions, though this point is increasingly overlooked.
Burden:
1) A burden primarily for the individual
patient or secondarily for others imposed by illness or disorder, or by treatment* or lack
of treatment. A burden may be physical, mental, emotional, spiritual, or
economic. Life itself is not a burden.
2) A burden for the individual patient or others imposed by illness or disorder,
or by treatment* or lack of treatment, or by quality of life. A burden may be
physical, mental, emotional, spiritual or economic. Life itself may be a burden.
Application
1) A decision to withdraw or withhold treatment* may be
justified when the treatment is very painful but of doubtful value, or is extraordinarily
expensive for the patient and his family.
2) A decision to withdraw or withhold treatment may be
justified if the patient is burdened by a life that is not worth living.
Care:
1) Care (as distinct from
treatment*) does not effect a cure. Ordinary care includes shelter, clothing, food,
water, company, sympathy, patience, spiritual support and other things needed to relieve
suffering, comfort the patient and preserve his life. Oral feeding is ordinary care
and may not be withdrawn or denied, regardless of the patient's condition. In some
limited circumstances, when death is imminent, medically assisted nutrition and hydration
may constitute extraordinary care, and may be withdrawn or denied.
2) (Understood as above, with the following exception). Oral
feeding and medically assisted nutrition and hydration constitute extraordinary care
or treatment* and may be withdrawn or denied.
3) Any service provided to a patient, whether considered care (1) or (2), or
treatment.* Some types of service may be withdrawn or denied.
Application
1) Accelerating or causing death by deliberate starvation and/or dehydration
is a serious breach of the duty of care.
2) Accelerating or causing death by deliberate starvation and/or
dehydration may be justified by a benefit-burden analysis
Choice:
1) An act of the will in the exercise of
its freedom. A choice is right if it is in accord with human
nature*; it is wrong if it is not in accord with human nature. The
freedom to choose is accompanied by the obligation to choose well. In moral matters,
a choice cannot be justified simply because it expresses a personal desire or preference.
2) A decision made by a person* in pursuit of personal value desire or
preference. All choices must be respected except those that interfere with
another person* without his consent.
Application
1) Some choices have no moral significance: choosing one kind of fruit to
eat rather than another. Some choices ought to be made: choosing to give the
fruit to a hungry child. Others are wrong: choosing to kill a child so that he
won't become hungry.
2) The choice of a mother to continue a pregnancy and give her child up for
adoption is morally equivalent to her choice to have an abortion, because the only
determinant of morality is the fact that she has made a choice.
Common Good:
1) The "good" that is common to
all human beings simply because they are human beings: food, shelter, clothing ,education,
friendship, religion, etc.
2) The "good" of the greatest number of people in a society.
Application
1) The common good is not served by depriving a patient of ordinary
care or treatment.
2) The common good may require that a patient be deprived of ordinary
treatment or care.
Conception:
1) Fertilization*: the union of sperm and
egg.
2) Implantation: the implantation of the early embryo in the endometrium (lining
of the womb) at about 5 to 7 days gestation.
Application
1) A human being exists as soon as fertilization* is complete.
Destruction or experimentation at any point after fertilization* is destruction or
experimentation upon a human being.
2) A human being cannot exist at any point prior to implantation. At a
minimum, artificial reproduction, experimentation and destruction are permissible between
fertilization and implantation.
Conscience:
1) A function of the intellect that
judges whether an act is morally good or evil. The judgement must be in accord with
objective reality and an objective standard of morality. If conscience is to judge
correctly, it must first be made cognizant of objective reality and the objective moral
standard it is to apply. Conscience can err. One therefore has a grave
obligation to form one's conscience correctly.
2) An intellectual faculty that independently constructs a personal ethical norm
that guides one's conduct. In some cases, a personal ethical norm ought to
yield to a collective ethical norm.
3) The faculty that senses whether or not conduct is in accord with personal
comfort or desire. In some cases, personal comfort or desire may have to yield
to the needs of others.
Application
1) (Objective moral principle [major premise]): it is always wrong to
intentionally kill an innocent human being; (Principle applied [minor
premise]) : a patient in a persistently dependent state is an innocent human
being; (Judgment of conscience) it is wrong to intentionally kill a patient in
a persistently dependent state.
2) This persistently dependent patient values personal autonomy above all else
and has asked to be killed. I also value personal autonomy above all else. I
will help to kill the patient, if two of my colleagues agree.
3) Nurses who are uncomfortable with late term abortions need not
participate in them, unless there are no others available to participate in a particular
case. In that case they will have to set aside their religious feelings and personal
discomfort and assist the patient.
Contraception:
1) Any act, before, during, or after
sexual intercourse, intended to prevent conception (1)*.
2) Any act, before, during or after sexual intercourse, intended to
prevent conception (1 or 2)*.
Application
1) Condoms are a form of contraception. Natural family planning is not,
because, during the non-fertile phase, no egg exists and fertilization need not be
prevented.
2) 'Morning after' pills may not prevent fertilization, but they are
contraceptives. Laws that protect conscientious objectors to abortions do not
protect people who refuse to provide 'morning after' pills.
Contraceptive:
1) A drug or device, used before,
during or after sexual intercourse, intended to prevent fertilization*.
2) A drug or device, used before, during or after sexual intercourse, intended
to prevent fertilization or implantation.
Application
1) Condoms are a form of contraception. Natural family planning is not,
because, during the non-fertile phase, no egg exists and fertilization need not be
prevented.
2) 'Morning after' pills may not prevent fertilization, but they are
contraceptives. Laws that protect conscientious objectors to abortions do not
protect people who refuse to provide 'morning after' pills.
Dignity (Human):
1) The true worth or value of a
human being.
2) Dignification: the dignified bearing, manner or appearance of a mature,
independent adult.
Application
1) Clipping the toenails of a dependent patient expresses respect for his human
dignity.
2) Having to have one's toenails clipped is undignified and therefore an
offence against human dignity.
Double Effect, Principle of:
1) Sometimes an action will have both good and bad effects. In some
cases, when the good effect is intended, the action may be justified by the Principle of
Double Effect. Four conditions must be met before this principle can be applied.
2)
Since there is no such thing as an action that is good or bad in
itself, but only an action that has good or bad consequences, the principle of double
effect is unworkable. Instead, an action is justified if the good consequences
outweigh the bad.
3) When both the good and bad effects of a given action can be
foreseen with moral certainty, it is meaningless to say that only the good effects are
intended when the action is chosen. An action is justified if the good consequences
outweigh the bad.
Application
1) Using the example of removal of a cancerous uterus:
(a) the action must be good in itself (removal of a diseased organ)
(b) the good effect (curing disease) is not obtained by means of the evil effect
(subsequent infertility)
(c) there is sufficient reason (saving life) to permit the evil effect (infertility)
(d) the evil effect is not intended, but merely tolerated. (what is intended is curing
disease/saving life, not sterilization, which is the unintended and undesired side effect)
2-3) Sterilization of a woman who has had all of the children she wants
to have is justified because the destruction of her fertility will be more than made up
for by her increased ability to care for the children she already has.
Emergency:
1) A situation in which it is morally
certain that the failure of health care workers to intervene would imminently endanger
life or result in bodily harm.
2) A situation in which the failure of health care workers to intervene would
imminently endanger life, result in bodily harm, or result in conception or the
continuation of a pregnancy not desired by the patient.
Application
1) A woman who failed to use contraceptives*, or whose contraceptives
failed, is not treated as a medical emergency.
2) A woman who failed to use contraceptives* or whose contraceptives
failed, must be treated as a medical emergency.
Euthanasia:
1) Euthanasia is an action or omission
which is intended to cause death in order to eliminate suffering or to extinguish a 'life
not worth living'. Euthanasia can be voluntary in which case it is also
suicide, whether or not it is 'assisted'. It can be involuntary, when it
against the victim's will. It can be nonvoluntary when the patient is unable
to give or withhold his consent. The denial or withdrawal of ordinary
treatment* or care* (including nutrition and hydration) is euthanasia; the denial or
withdrawal of extraordinary treatment* or care* is not.
2) Euthanasia is active if it is an action which is intended to cause
death in order to eliminate suffering or to extinguish a life not worth living (the
injection of a poison). It is passive if it is an omission that is intended
to result in death in order to eliminate suffering or to extinguish a life not worth
living (the withdrawal or denial of treatment* or care*, whether ordinary or
extraordinary*). The distinctions between voluntary, involuntary and nonvoluntary
euthanasia are acknowledged.
Application
1) The withdrawal or refusal of extraordinary treatment* or care*
does not justify the withdrawal or refusal of ordinary treatment* or care*, or actual
killing.
2) The withdrawal or refusal of treatment* or care* is passive rather than
active, and is widely accepted. Since killing by passive means is accepted, but is
sometimes slow and painful, one should accept quicker and more humane killing by drug
injection.
Extraordinary (Disproportionate) Means:
1) Applied to care* or treatment*, refers
to measures that impose excessive burdens* or carry unusual risks,
primarily for the patient and secondarily for the family and community, but which promise
little in the way of cure or relief for the patient. The concept of burden* refers
to burdensome treatment or care, not to life burdened by suffering. All
experimental and research regimens constitute extraordinary means. Extraordinary
measures are not morally required.
2) Applied to care* or treatment*, refers to measures that impose excessive
burdens* or carry unusual risks for the patient, family, or community, but which promise
little in the way of cure or relief. The concept of burden* may refer to
burdensome treatment or care or to life burdened by suffering.
Application
1) A patient for whom death is imminent may find medically assisted nutrition
and hydration burdensome and of limited benefit, especially if his ability to assimilate
nourishment is diminishing. In such a case, nutrition and hydration may be
withdrawn. In other cases, including those of persistently unconscious patients, a
benefitburden assessment does not justify dispensing with medically assisted nutrition and
hydration (in modern medical settings).
2) A patient suffering from a debilitating illness (such as advanced
Lou Gehrigs disease) may reasonably hold that life is not a benefit*, but a burden*.
In this case, any treatment* or care* that maintains or prolongs life may be dispensed
with.
Fertilization:
The union of sperm and egg,
which begins when sperm and egg meet and concludes with the intermingling of
male and female chromosomes, a process that takes about 24 hours.
Fertilized Egg:
1) An inaccurate and unscientific term. Once fertilization is complete,
the egg does not exist. What exists is the single cell human zygote, the
beginning of the embryonic stage of growth of a genetically unique male or female,
individual human being.
2) The product of fertilization*.
Application
1) The product of fertilization* is a human being. At a minimum, this
means that significant ethical issues arise in the treatment of the early human
embryo.
2) The product of fertilization* is a fertilized egg, not a human being,
and can thus be used for genetic research or destroyed.
Freedom:
1) The capacity to choose either good or
evil. The liberty that makes possible the performance of morally good acts, the
corollary of which is the possibility of choosing evil.
2) The liberty necessary for achieving personal happiness by the exercise of
choice. Freedom from constraints or responsibilities that impede personal choice.
Application
1) Freely accepting the responsibility of caring for a seriously ill person is an
affirmation of human dignity* and the value of human relationships.
2) Caring for a seriously ill person imposes constraints upon personal liberty.
Genetic Termination / Induction:
An abortion*, frequently late-term,
performed for eugenic reasons.
Implantation:
The implantation of the early embryo in
the endometrium (lining of the womb) about 5 to 7 days after fertilization/conception*.
Infanticide:
1) In law, the killing of a newborn
child by its mother in circumstances of diminished criminal responsibility. A lesser
offence than murder.
2) Generally, the killing of infant children.
Nature/Natural:
1) That which is essentially
characteristic of a creature; a creature has a nature. The nature of a dog is not
the same as the nature of a shark. Some philosophies include social structures under
the rubric of the natural, because man is social by nature.
2) All the world except man. Anything that is not artificial
(man-made). The connotation is that what is natural is good, and what is unnatural
(artificial) is bad.
3) Related to (2), freedom from laws, rules or customs, which are perceived to be
artificial. Again, what is natural is good, and what is unnatural is bad.
4) Normal: what many or most people do. Same connotation as in (2) and
3).
5) In New Age, or in pagan pantheistic gnosticism, "Nature",
including man, is part of the divine.
Application
1) Man is a rational creature. Acting unreasonably is contrary to his
nature. It is unreasonable to take drugs that diminish good health and one's
intellectual faculties. Therefore, illicit drug use is contrary to human nature.
2)
Organically grown marijuana is a purely natural product, unlike
synthetic hormones and other manufactured drugs. Its use should not be proscribed.
3) Marijuana smoking was suppressed only because puritan laws
were imposed by society. Without the interference of organized religions,
government, and other power structures, people would smoke marijuana if they wanted to,
others would not, and everyone would be better off.
4) Many people from all social classes, levels of education and all
age groups smoke marijuana. In many places it is as common as liquor
consumption. This must mean that it is a natural and, therefore,
acceptable thing to do.
5) Smoking marijuana provides a mystical experience that more closely
unites man to the rest of the cosmos.
Ordinary (Proportionate) Means:
1) Applied to care* or treatment*, refers
to measures that do not impose excessive burdens* or carry unusual risks,
primarily for the patient and secondarily for the family and community, and which
are reasonably believed to be good for the patient.
Ordinary measures are always obligatory.
2) Applied to care* or treatment*, refers to measures whose benefits* for
the patient outweigh the burdens*
3) Applied to care* or treatment*, refers to measures whose benefits*
for the patient and others outweigh the burdens*.
Application
1) A patient in a modern medical setting must be provided with medically
assisted nutrition and hydration, even if this does nothing to remedy his condition.
Such measures remain sound health care*. They benefit the patient because they
sustain life, express loving concern for the helpless, and prevent suffering from hunger
and thirst.
2-3) A patient suffering from a debilitating illness (such as
advanced Lou Gehrigs disease) may reasonably hold that life is not a benefit*, but a
burden*. Further: family members may find it emotionally and physically
draining to support the patient in the long term. In this case, any
treatment*or care* that maintains or prolongs life may be dispensed with.
Partial food and hydration:
Providing insufficient amounts of
food and hydration so that the patient slowly dies, but the patient and the family THINK
the patient is receiving normal and sufficient food and hydration
Person:
1) A human being, from the moment of
conception(1)* to death; a member of the human species.
2) In law, a possessor of rights. The definition accords with the
practical needs of a given society and its legal tradition. Science may play little
or no part in the construction of the definition. For example: it is customary to
confer juridical personhood upon a company by the legal process of incorporation.
3) A human being who is self-aware and able to communicate with others.
4) A human being who is self-aware.
5) Any animal that appears to demonstrates self-awareness and an ability to
communicate.
6) Any animal that appears to demonstrates self-awareness.
Application
1) It is immoral to deliberately kill an innocent non-aggressive human being
from the moment of conception/fertilization until death. This precludes abortion and
euthanasia.
2) In Canada, the law confers personhood only at birth. Killing
children in utero for the purpose of harvesting tissue is not illegal.
3)
A patient in a coma is not a person, and has does not have the
right to health care that a person has.
4) A newborn infant is not a person and is not morally entitled to the
protection that the law affords to persons.
5-6) Newborn human infants, the comatose and mentally ill may be
substituted for animals in experimental research.
Post-coital Interception:
1)
Use of drugs after intercourse to prevent ovulation.
2) Use of drugs after intercourse to prevent implantation*.
Application:
1) Post-coital interception does not cause the destruction of a
developing early embryo.
2) Post-coital interception causes the destruction of a developing
early embryo.
Pre-Embryo:
An inaccurate and unscientific term used by some writers to denote what is
actually the early human embryo, including the single cell human zygote, 8-cell
stage embryo, morula, and blastocyst (5-7 days).
Application
What is a pre-embryo is not human, and may be destroyed or used for research purposes.
Pregnancy:
1) In the case of conception (1)*,
pregnancy begins with fertilization*.
2) In the case of conception (2)*, pregnancy begins with implantation. (5-7 days
after fertilization*).
Application
1) Drugs that prevent implantation of the early embryo are abortifacients* that
end pregnancy.
2) Drugs that prevent implantation of the early embryo are
contraceptives* that prevent pregnancy.
Right:
1) An entitlement, intrinsic to a
human being, that reflects the moral obligations of other persons that arise from the
nature* of man. Basic human rights ought to be recognized by the state, but they are
not conferred by the state, and the state cannot take them away.
2) An entitlement that the state may bestow upon or deny to persons (2)*, or
that may be obtained by persons (2)* by the exercise of autonomous or collective effort.
Application
1) Since there is no moral obligation to help someone kill another human
being, there can be no right to abortion*, euthanasia* or assisted suicide.
2) Lobbying efforts may convince the state to grant a right to abortion*,
euthanasia*, or assisted suicide.
Treatment:
1) Measures directed toward the
restoration of health by curing disease or correcting disabilities. Nutrition and
hydration are part of nursing care*, not treatment. Ordinary* treatment must
be provided and accepted.
2) Measures directed toward the restoration of health by curing disease or
correcting disabilities. Nutrition and hydration, especially when the patient must
be assisted manually or technologically, are considered treatment. All
treatment can be refused.
Application
1) Surrogates cannot, on behalf of an incompetent patient, order cessation of
nutrition and hydration.
2) Since a patient can refuse treatment, surrogates can refuse food and
fluids on behalf of an incompetent patient.
Values:
Things that are valued, thought to be
important by a person or class of persons (hence: personal values, family values, cultural
values, etc.). The importance or worth assigned to something that is valued is
always subject to adjustment when other values conflict. No standard exists by which
to determine which values (or whose values) ought to prevail. Values are not
virtues, nor are they principles.
Application
1) A nurse must put aside her personal values when they conflict with her
client's wishes
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