HEALTH CARE ETHICS

MODULE 3

3.1 HUMAN SEXUALITY AND MARRIAGE

A. SEXUALITY & HUMAN REPRODUCTION

 SEXUALITY is a fundamental component of personality, one of its modes of
being, of manifestations, of communicating to others, of feelings, of
expressing, and of living human love. Femininity and masculinity are
complementary gifts through which human sexuality becomes an integral
part of the concrete capacity for love, which God has inscribed in man and
woman. It characterizes man and woman not only on the physical but also
on the psychological and spiritual levels, making its mark on each of their
expressions. Such diversity, which is linked to the complementarity of the
two sexes, allows thorough response to the design of God according to the
vocation to which each one is called.
 Various connotations on the word “sexuality”:
1. It is the totality of characteristics proper to each sex of human species
and all animals & plants that reproduce through the union of specific but
different cells: one masculine and the other feminine.
2. Sometimes is understood, even among higher beings, as a specific
aspect, example, the attraction towards individuals of the opposite sex.
This impulse is instinctive in animals, however in man, taking into
account his rationality and influence of the will on his behavior, it adopts
other modalities. Hence, sexual tendencies or impulse is the preferred
phrase to be used in human sexuality rather than “sexual instinct”.
3. It identifies with “genitality”. It is directly related to the mode of
propagation of the species. In other words, sexuality, a sum total of
various characteristics, is reduced to the level of the phenomena and
mechanisms involving the genital organs & their physiology. In similar
restricted but opposite sense, sexuality is understood by some as the
sum total of genetic, anatomical, hormonal, physiological, &
psychological constituents of a man or a woman, as the case maybe,
abstracted from what is specifically genital. Both ways of understanding
sexuality result from prejudices of the rational will, the distinction being
merely speculative. This is because in reality one cannot completely
separate sexuality from genitality. However, this distinction is useful
because it permits the study of many related problems.
 The study of sexuality can be approached from different perspectives. These
are biological, psychological, philosophical and theological perspectives. In
order to understand if fully, however, a holistic outlook is needed. One must
analyze the different elements which comprise it and integrate them into the
whole person.
 In synthesis, the essential elements would include:
1. The sexual instinct or tendency is innate (inborn); theological (ordained
towards an end – procreation); transcends psychologically (ordained
towards another person away from self); does not need intelligence but
is regulated by the latter.
2. Man is sexual. This however, does not mean that he has no other quality
besides being sexual. Though always present, sexuality is not
everything.
3. Sex is an objective reality in accord with God’s plan for man; therefore it
is good in itself. However, sex must be subjected to moral norms just as
anything worthwhile remains within the just limits of the spirit. Thus sex
 life ought to be regulated morally according to Natural Law. The first
principle of the sexual life is: marriage is the only natural way willed by
God wherein sexual life may be exercised morally.
4. Sexuality is the biological vehicle for self-giving between man and
woman. However, human love involves everything – all the dimensions
of “being”, including the affective and spiritual. Sexuality ought to be at
the service of the person. Today, the tendency is to dissociate love from
sex. In other words, “love” is used as a simple requisite to practice sex.
5. The sexual instinct is ordained essentially to the propagation of the
species, to the transmission of life. Therefore, the unitive and procreative
aspects of sexual love must not be separated.

B. MARRIAGE
 The essence of the natural contract of marriage is the formal, mutual &
externally expressed agreement between man & woman to bestow upon
each other, permanently & exclusively, the right to natural sexual relationship
& to all other commonly understood features of married life. Thus, PURE
CONJUGAL LOVE is the only legitimate force which underlies the making of
this contract.
 Marriage comes into existence when a man & a woman, forswearing all
others, through an act of irrevocable personal consent freely give
themselves to one another. It is based on a definitive decision, the consent.
It is established in & through the free, self-determining personal choice of the
spouses; thus it is a person-affirming reality.
 Man & woman = consent freely in giving themselves to one another through
an act of irrevocable personal consent.
 Components: (1) Definitive decision – consent; (2) free, self-determining
choice on both sides; (3) man & woman called as “SPOUSES”.
 MARRIED LOVE (CONJUGAL LOVE) - openness to the other person & in
self-giving taking the form of a total give that belongs to the state of life. To
this kind of love alone belongs sexual giving – an integral part of love by
which a man & a woman commits themselves totally with one another until
death. The bodily gift of a man & a woman in marriage is the outward sign of
the communion of persons existing between them.
 LEGAL ASPECT OF MARRIAGE: The Family Code of the Philippines
defines marriage as a special contract of permanent union between a man &
a woman entered into in accordance with the law for the establishment of a
family.
 What love is not: People experience love for many wrong reasons – it is
frequently portrayed as a feeling for somebody of the opposite sex to
achieve happiness; at times it is portrayed as pleasure, a philosophy (called
hedonism) characterized by the belief that maximization of pleasure
accompanied by the minimization of pain is the fundamental moral principle
of human life; for some love has come to mean engaging in the sexual act.
This seduction leaves out values such as fidelity, exclusiveness,
dependability, stability, childbearing, founding of a family, & love of children.
 A theological reflection of the scriptural passages reveals 3 crucial truths
about the bonding of man & woman in marriage. These are:
1. That man & woman are equally persons;
2. That God is the author of marriage & the one who gives its defining
characteristics;
3. That men & women are persons with body & soul, not merely spirit
persons.
 Conjugal love is the faithful and exclusive love that unites the spouses
according to their truth as images of God. It is also an act of the total person
 & not an instinctive impulse. It embraces the totality of body & soul of the
human person.
 CHARACTERISTICS OF CONJUGAL or MARRIED LOVE:
1. It is human love (physical & spiritual) which means saying “yes” to
someone else and “no” to oneself. By it, husband & wife become one
heart, one soul, & together they attain their human perfection.
2. It is total. A married person loves generously & shares things without
reservations or selfish calculations.
3. It is faithful & exclusive. The adjective “committed” describes how true
married love involves a pledging of oneself to another. Married love is
not self-centered but looks to the other partner.
4. It is fruitful. The matrimonial consent has two essential elements:
conjugal love & ordination to children.
 The “gift” of marriage or matrimony is a “sacrament”, a “vocation” and a
“commandment” of Christian spouses, that they may remain faithful to each
other forever, beyond every trial & difficulty, in generous obedience to the
holy will of the Lord: “What therefore God has joined together, let no man put
asunder”
 CAUSES OF MARRIAGE: What brings a man & a woman together?
1. Final cause (purpose of the institution). Primarily, it is the begetting &
upbringing of children. Secondarily, it is the mutual help between the
spouses & companionship.
2. Efficient cause (the agent who brings it about). It consists of the spouses
motivated by a free decision to love each other for life, issuing in a
formal & public declaration (because man live in society) to remain
together until one of them dies.
3. Formal or constitutive cause (what makes it a marriage). It is the mutual
self-giving (or matrimonial consent) thus expressed & never withdrawn if
what they have entered into is a marriage union not just mating.
4. Material cause – are the living bodies of the spouses, over which they
acquire mutual rights.
 Three Crucial Truths of the Bonding of a Man & Woman in Marriage
1. That man or woman are equally persons.
2. That God is the author of marriage & the one who gives its defining
characteristics.
3. That men & women are persons with body & soul, not merely spirit
persons.
 REASONS OF FAULTY MARRIAGE
1. The tendency to divinize human love, expecting from human love what
true believers know only God can give.
2. The tendency to confuse the purpose (end) of marriage with the motives
that lead to individuals to marry.
3. The tendency to see contradictions between these factors, instead of
seeing them as complementary to one another.
 PROPERTIES OF MARRIAGE
1. Unity – exclusive union of one man & woman
2. Indissolubility – indestructible bond
3. End of marriage – procreation & education of children for God
C. FAMILY
‒ Is based on marriage & open for the transmission of life.
‒ A natural society exists prior to the state or any other community = rights.
‒ Is the place where different generations come together & help one another
to grow in wisdom & to harmonize the rights of individuals.
‒ A community of love & solidarity.
‒ Composed of one or more individuals closely related by blood, marriage or
friendship.
 ROLE OF THE FAMILY
1. Complementary function in the defense & advancement of the
good of every member & of humanity.
2. Birth spacing & number of children to be born.
3. Should respect & protect human life from the product of
conception.
4. Educate the children.
 GENERAL TASKS OF THE FAMILY
1. To form a community of persons.
2. To serve.
3. To participate in the development of society.
4. To share in the life & mission of the church.
 TYPES OF FAMILY
1. TRADITIONAL FAMILY – an autonomous unit in which both
parents reside in the home with their children, wherein the mother
assumes the nurturing role & the father provides the necessary
economic resources.
2. TWO-CAREER (Dual Career) FAMILY – both husband & wife are
employed. They may or may not have children. Finding quality &
affordable childcare is one of the greatest stresses faced by
working parents.
3. SINGLE-PARENT FAMILY – reasons for single parenthood would
include death of a spouse, separation, birth of a child to an
unmarried woman or adoption of a child by a single woman or
man. Stresses may include: childcare concerns, inadequate
financial resources, role overload & fatigue in managing daily
tasks & social isolation.
4. ADOLESCENT FAMILY – parents are young. They
developmentally, physically, emotionally & financially ill-prepared
to undertake the responsibility of parenthood. It interrupts or stop
formal education. Children are often at greater risk for health &
social problems.
5. BLENDED (Reconstituted) FAMILY – existing family units who
join together to form new families. Families with children living with
a birth and no birth parent are commonly called step families.
Stresses occur as blended families get acquainted with each other,
respect differences, & establish new patterns of behavior.
6. COHABITING (Communal) FAMILY – families consist of
unrelated individuals or families who live under one roof. Reasons
for cohabiting may be a need for companionship, a desire to
achieve a sense of family, testing a relationship or commitment, or
sharing expenses & household management.
7. GAY & LESBIAN FAMILY – Children raised in this family unit
develop sex role orientation & behaviors similar to their parents.
8. SINGLE-ADULT LIVING ALONE
D. CONTRACEPTION
‒ The voluntary prevention of conception by the positive use of artificial
means, which hinders the generative cells from uniting during sexual act.
 METHODS OF CONTRACEPTION
1. FOLK METHODS
a. Pre-coital/post coital douche – use of vinegar and brine which
has a spermicidal effect used as douche pre or post coital.
Another that is use is Coca-cola, the woman holds her thumb
over the open bottle in the vagina, removes her finger &
allows the gaseous content to erupt inside the body.
b. Prolonged lactation – it delays ovulation as result of the
hormonal imbalance occurring inside the mother’s body.
c. Withdrawal (Coitus interruptus) – this involves withdrawal of
the penis from the vagina immediately before ejaculation;
hence coitus is “interrupted” just prior to orgasm, and the male
ejaculates outside the female organ. Some couples find this
method very disturbing & it may lead to sexual dissatisfaction
& irritability in sexual relations especially when the male
insists on withdrawal over the female. All couples commonly
know this kind of method as “interrupted melody”.
d. Coitus reservatus – the male withholds ejaculation just before
orgasm & allows erection to subside gradually, hence, coitus
is “reserved” or “kept in reservation”.
2. MECHANICAL METHODS – involves blocking the sperm from
entering the uterine cavity to prevent conception. These methods
include the use of: condoms, diaphragm, & sponge
3. CHEMICAL METHODS – involves the use of spermicides that
prevent conception by killing the sperm cells before they enter the
uterine cavity or reach the fallopian tubes. These includes: vaginal
suppository, vaginal tablets, vaginal jellies, creams & foams.
4. HORMONAL METHODS – use of contraceptive pills. A
combination of synthetic hormones, usually estrogen &
progesterone. It maintains a high hormonal level which prevents
the ovary from releasing an egg, thus controlling conception no
matter how often the couple engages themselves in sexual
relations. Also injections & implants.
5. ABORTIFACIENTS – anything used to cause abortion or
expulsion of the fetus. Examples: Intrauterine device (IUD), DES
(Diethylstilbestrol) or morning pill, Prostaglandin, antipregnancy
vaccine, & low-dose type of contraceptive pill.
 MORALITY OF CONTRACEPTION
‒ Contraception is by the nature of its very word - “against life”. It is
a willing that a life not exist, or come into existence. It separates
the procreative and unitive meanings of the conjugal act; it
destroys the union of life and love, the very essence of our
existence and created being.
‒ Any conjugal act must be open to the transmission of life.
‒ The catechism of the Catholic Church states: “Sexual pleasure is
morally disordered when sought for itself, isolated from its
procreative & unitive purposes.” Love & sexuality can neither be
identified with each other nor can they be separated.
HUMAN SEXUALITY
 SEXUALITY – is a fundamental component of personality,one of its modes of
being, of manifestations, of communicating to others, of feelings, of expressing,
and of living human love. Femininity and masculinity are complementary gifts
through which human sexuality becomes an integral part of the concrete
capacity for love, which God has inscribed in man and woman.
 Various connotations:
1. Masculinity & femininity
2. Attraction towards individuals of the opposite sex
3. It identifies with genitality
 The SEXUAL INSTINCT or TENDENCY is innate (inborn); theological (ordained
towards an end – procreation); transcends psychologically (ordained towards
another person away from self); does not need intelligence but is regulated by
the latter.
 Man is sexual. This however, does not mean that he has no other quality
besides being sexual. Though always present, sexuality is not everything.
 Sex is an objective reality in accord with God’s plan for man; therefore it is good
in itself. However, sex must be subjected to moral norms just as anything
worthwhile remains within the just limits of the spirit. Thus sex life ought to be
regulated morally according to Natural Law. The first principle of the sexual life is:
marriage is the only natural way willed by God wherein sexual life may be
exercised morally.
 Sexuality is the biological vehicle for self-giving between man and woman.
However, human love involves everything – all the dimensions of “being”,
including the affective and spiritual. Sexuality ought to be at the service of the
person. Today, the tendency is to dissociate love from sex. In other words, “love”
is used as a simple requisite to practice sex.
 The sexual instinct is ordained essentially to the propagation of the species, to
the transmission of life. Therefore, the unitive and procreative aspects of sexual
love must not be separated.

MARRIAGE
 Man (self-giving) = relationship
 Recognize & love the other themselves (not as an object)
 Love generates communion with the other person (what is good for the other as
his / her own good)
 True love therefore finds its meaning in SELF-GIVING.
 Man = called to love and self-giving
 In unity of body & soul
 Love = is lived out of marriage, it surpasses & includes friendship
 Love = man & woman = giving themselves totally = masculinity & feminity (both
complementary gifts)
 Completely realizes his existence only by existing with another & even more
deeply for someone.
 MARRIAGE – a love rooted in the will embracing the goodness of the whole
person.
 What Love Is Not ……
1. Feeling for somebody of the opposite sex to achieve happiness.
2. Love is pleasure.
3. Engaging in sexual act.
 Man & woman = consent freely in giving themselves to one another through an
act of irrevocable personal consent.
 Components:
1. Definitive decision – CONSENT
2. Free, self-determining choice on both sides = new & lasting identity
 3. Man = husband & the woman = wife, thus called SPOUSES.

 MARRIED LOVE
1. Openness to the other person & total give that belongs to the state of life.
2. To this kind of love alone belongs sexual giving – an integral part of love by
which a man & a woman commit themselves totally with one another until
death.
3. The bodily gift of a man & a woman in marriage is the outward sign of the
communion of persons existing between them.
 CHARACTERISTICS OF MARRIED LOVE
‒ Human love
‒ Total
‒ Faithful & exclusive
‒ Fruitful
‒ Conjugal love reveals its true nature & nobility when it is considered in
its supreme origin - GOD
 CAUSES OF MARRIAGE
1. Final Cause (the purpose/end of marriage) – procreative (begetting &
upbringing of children) & unitive (mutual help between spouses &
companionship)
2. Efficient Cause (what brings it about) – the spouse motivated by a free
decision to love each other for life.
3. Formal Cause (what makes it a marriage) – the mutual self-giving
(matrimonial consent) expressed & never withdrawn
4. Material Cause – the living body of the spouses.
 THREE CRUCIAL TRUTHS OF THE BONDING OF A MAN & WOMAN IN
MARRIAGE
1. That man or woman are equally persons.
2. That God is the author of marriage & the one who gives its defining
characteristics.
3. That men & women are persons with body & soul, not merely spirit persons.
 REASONS OF FAULTY MARRIAGE
1. The tendency to divinize human love, expecting from human love what true
believers know only God can give.
2. The tendency to confuse the purpose (end) of marriage with the motives that
lead to individuals to marry.
3. The tendency to see contradictions between these factors, instead of seeing
them as complementary to one another.
 PROPERTIES OF MARRIAGE
1. Unity – exclusive union of one man & woman
2. Indissolubility – indestructible bond
3. End of marriage – procreation & education of children for God
 MARRIAGE
‒ “A lifetime contract with spouses as ministers.”
‒ “An institution of the natural law. Not just a social one.”
‒ “A school and source of life.”
‒ “A sacrament, a union of three partners: man, woman and God.”
 CHRISTIAN MARRIAGE
‒ It is a community of persons, brought to life by love, at service of life,
established by Christ as a sacrament and a way to holiness.
FAMILY
 Is based on marriage & open for the transmission of life.
 A natural society exists prior to the state or any other community = rights.
 Is the place where different generations come together & help one another to
grow in wisdom & to harmonize the rights of individuals.
 A community of love & solidarity.
 Composed of one or more individuals closely related by blood, marriage or
friendship.
 ROLE OF THE FAMILY
1. Complementary function in the defense & advancement of the good of every
member & of humanity.
2. Birth spacing & number of children to be born.
3. Should respect & protect human life from the product of conception.
4. Educate the children.
 GENERAL TASKS OF A FAMILY
1. To form a community of persons.
2. To serve.
3. To participate in the development of society.
4. To share in the life & mission of the church.
 TYPES OF FAMILY
1. Traditional family
2. Two-career family
3. Single-parent family
4. Adolescent family
5. Blended family
6. Cohabiting family
7. Gay & Lesbian family
8. Single Adults living alone
 THE FAMILY
‒ The basic unit of the society.
‒ The primary & natural school of life.
‒ The facilitator of & the key to total development of members.
‒ A mini domestic society, wherein responsible citizens are formed.
‒ Vested with rights & interests which must be served & defended by the state.
‒ The provider of the learning environment for members to learn & practice
values, heritage, friendship & love

CONTRACEPTION
 The voluntary prevention of conception by the positive use of artificial means,
which hinders the generative cells from uniting during sexual act.
 METHODS OF CONTRACEPTION
1. FOLK METHODS
a. Pre-coital /post coital douche
b. Prolonged lactation
c. Withdrawal (Coitus Interruptus)
d. Coitus reservatus
2. MECHANICAL METHODS – involves blocking of the sperm form entering the
uterine cavity to prevent conception.
a. Condom
b. Diaphragm
c. Sponge
3. CHEMICAL METHODS – involves use of spermicides by killing the sperm
cells before they enter the uterine cavity or reach the fallopian tubes.
a. Vaginal suppository
b. Vagina tablets
 c. Vaginal jellies, creams & foams
4. HORMONAL METHODS use of contraceptive pill, usually a combination of
estrogen & progesterone.
a. Contraceptive pills
b. Injections & implants
5. ABORTIFACIENTS – includes anything used to cause abortion or expulsion
of fetus.
a. Intrauterine device (IUD)
b. DES (Diethylstilbestrol) or morning pill
c. Prostaglandin
d. Anti-pregnancy vaccine
e. Low-dose type of contraceptive pill
 MORALITY OF CONTRACEPTION
‒ Contraception is by the nature of its very word- “against life.” It is a willing
that a life not exist, or come into existence. It separates the procreative
and unitive meanings of the conjugal act; it destroys the union of life and
love, the very essence of our existence and created being.
‒ Any conjugal act must be open to the transmission of life.
‒ The catechism of the Catholic Church states: “Sexual pleasure is morally
disordered when sought for itself, isolated from its procreative & unitive
purposes.” Love & sexuality can neither be identified with each other nor
can they be separated.

3.2 HUMAN REPRODUCTION

HUMAN REPRODUCTION is an essential process that continues the existence of
species here on earth. The following videos presented were the processes in human
reproduction that are ethically and morally questioned:

A. ARTIFICIAL INSEMINATION. This is a medical intervention of injecting semen

in the female vagina or uterus for the purpose of achieving pregnancy. This is
done usually when males are impotent or sterile, or if the couple is infertile.
B. IN-VITRO FERTILIZATION (IVF) is another form or option for fertilizing embryos
if there is a fertility problem with the couple or individual wanting to get pregnant.
This is an invasive procedure and is expensive. The process involves retrieving
eggs from the women then fertilizing it with the male’s sperm. This is mixed in a
petri dish to produce an embryo. After monitoring for a formed embryo, it will be
then implanted into the woman’s uterine wall for pregnancy to occur.
C. SURROGATE MOTHERHOOD occurs when women who cannot bear a child in
her womb but want to have a child may choose to have surrogacy wherein
another woman carries the child and delivers it for the couple. It is also an option
for LGBT couples who want a child. Surrogacy is enabled through IVF process
and
D. ABORTION is the medical process of eliminating a fetus from the uterus to end
pregnancy. Miscarriage or spontaneous abortion is one type that is done due to
causes that are beyond human control such as serious medical problem to
mother or the fetus. Another type is the induced abortion done due to voluntary
and own will of the human person to cause end of fetus’ life based to their own
specific reasons. Abortion has been a long discussion coming from different
opinions and beliefs among groups and communities. There are several things to
consider, validate, and justify with this process such as whether or not the fetus
is a human being; the rights of the pregnant woman as opposed to those of the
fetus, and circumstances of horror and hardship that might surround a
pregnancy.
E. STEM CELL THERAPY is for the prevention of diseases or conditions that
negatively impacts life. It is designed to repair damaged cells within the body by
directly administering cells into the bloodstream. It is a promising strategy,
however, ethical considerations are also present such as the unlimited
differentiation potential of iPSCs which can be used in human cloning, as a risk
for generation of human embryos and human-animal chimeras.

ETHICAL CONSIDERATIONS
Particular requirements and conditions are needed to obtain before proceeding with
the Artificial insemination, In-vitro fertilization, Surrogate Motherhood, Abortion, and
Stem cell therapy procedures. First, the opinions and beliefs of the client that will
undergo the said procedure should be considered and given understanding. There
should also be proper health teachings to the client to ensure their full insight with
regards to the procedure. Informed consent is then required before starting the
procedure, making sure that the client is all well-informed and clarified with the
activity to be conducted including the risk that they should anticipate for. Contract will
be needed as well to serve as record of rights, responsibilities, and obligations,
especially, for surrogacy cases. There is also a need to ensure confidentiality and
security of the client’s information and participation in the said procedure. In the case
of abortion, different countries has its own policies and law regarding it. Thus, strict
compliance from this should be observed. For stem cell therapy, one thing that
should be ethically considered is in respect to the human-subjects in clinical trials. It
must be carefully designed to protect the rights and welfare of trial subjects. Overall,
it is important to conduct the procedure in a systematic, evidenced-based, and
empirical manner to ensure the quality, holistic, and safe healthcare interventions.