BIOETHICS AND PROFESSIONAL CONDUCT

INTRODUCTION • Used unknowing human subjects exposed to

• The branch of philosophy concerned with extreme health risks
principles that allow us to make decisions about • "Moral basis" or purpose is to advance
what is right and wrong is called ethics or moral scientific knowledge
philosophy. • Other well publicized events in health care and
• Bioethics is specifically concerned with moral research questioned the norms of medical ethics
principles and decisions in the context of MODERN DAY BIOETHICS
medical practice, policy, and research. • Emerged from the atrocities and scandals in
• Moral difficulties connected with medicine are human experimentation
so complex and important that they require • Horrific experiments performed on prisoners by
special attention. Medical ethics gives them this doctors in Nazi concentration camps
attention, but it remains a part of the discipline • NUREMBURG MILITARY TRIBUNAL
of ethics. TRIALS (Nov. 14, 1945 Oct. 1, 1946) –
• Thus, if we are to answer the question as to • NUREMBURG CODE- influenced the
whether there are any rules or principles to use direction of research ethics and policy
when making moral decisions in the medical • 1996: Dolly, the first cloned sheep; stem cell
context, we must turn to general ethical theories technology
and to a consideration of moral principles that • 2002: legalization of euthanasia in the
have been proposed to hold in all contexts of Netherlands, emergence of Right to Die
human action. advocates and movement, Oregon Death with
WHAT ARE BIOETHICS? Dignity Act
Morals • 2007: Terri Schiavo - end of life case,
• conviction or justifiable position based on termination of feeding
whether something is right or wrong. • A new discipline which tries to reconcile the
Ethics discrepancies between the 2400 year old
• study of moral standards & how they affect Hippocratic Code with today's medico-moral
conduct. issues
Bio FROM AN ETHICAL POINT OF VIEW,
• living organisms. MEDICINE IS THE VICTIM OF ITS OWN
Bioethics SUCCESS
• knowing right from wrong with living Today in medicine, the CRITERION OF WHAT IS
organisms, and then doing the right thing. GOOD (ethical or moral) is being replaced by WHAT
HISTORY OF BIOETHICS IS USEFUL (Utilitarianism)
The oath and prayer of MAIMOINIDES (c. 1200) UNESCO’S 15 BIOETHICAL PRINCIPLE
• Rabbi Moshe Ben Maimon, a Jewish
philosopher
• A meditative piece which implores physicians
to look at the sick with respect and dignity
OATH
"The eternal providence has appointed me to watch over
the life and health of Thy creatures. May the love for my
art actuate me at all times: may neither avarice nor
miserliness; nor thirst for glory or for a great reputation
engage my mind..."
ANCIENT HISTORY
HIPPOCRATIC OATH
- first code of medical ethics PRINCIPLES OF BIOETHICS
• "First do no harm" Respect for persons
• A promise to respect a patient's personal dignity • autonomy- informed voluntary consent
and privacy • protection of vulnerable persons
• A promise to use medical knowledge FOR THE Beneficence/Non-Maleficence
GOOD OF THE PATIENT • protection of rights
• 1966 article by Dr. Henry Beecher, Harvard • Investigator - study design
Univ., in the New England Journal of Medicine • wellbeing of subjects
(NEJM) • more benefits than risks
• Several unethical and experimental research Justice/Non-Exploitation
programs in clinical research in the U.S. • fairness
• equitable recruitment of participants

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• caring of vulnerable group Neuroethics
FOUR BIOETHICAL PRINCIPLE • Clinical neuroethics is a field at the intersection
Autonomy of neuroethics and clinical ethics, two dynamic
• respect individual ability to make decisions and exciting disciplines. Clinical neuroethics
about health and future. addresses topics such as consciousness, death,
Beneficence deep brain stimulation, pain, and enhancement
• actions intended to benefit. in the clinical setting.
Non-maleficence Precision Medicine
• intent not to harm. • Precision medicine is often ethically
Justice ambiguous. One goal of precision medicine is
• fair to the wider community in terms of the identifying biomarkers that predict
consequences. effectiveness in individuals.
SPECIFIC AREAS IN BIOETHICS Reproductive Ethics
Clinical Ethics • Reproductive ethics addresses topics that
• Is a practical discipline that provides a commonly provoke social and legal
structured approach for identifying, analyzing, controversy, and intimately connect to concerns
and resolving ethical issues in clinical over reproductive justice. The field looks at
medicine. issues related to assisting fertility (assisted
• Clinical ethics may be useful in the following: reproduction, surrogacy, genetic manipulation
➢ identify and clarify ethical questions of offspring), restricting fertility (contraception
find ethically acceptable course/ s of and sterilization), terminating a pregnancy
action (abortion), minors and access, and concerns that
➢ encourage honest and respectful are more general over maternal and fetal best
communication among all parties interests.
affected Shared Decision-Making
➢ recommend ethically acceptable • Effective clinical encounters depend on good
solution/s for the case in question communication. With the goal of arriving at the
➢ improve institutional responses to best possible decision for the individual patient,
ethical dilemmas shared decision-making is the process whereby
a healthcare decision is presented, discussed,
deliberated, and negotiated between the
provider and patient.
• In shared decision-making, a physician taps
their knowledge about the available evidence
and combines it with their experienced clinical
judgment to provide balanced information
regarding treatment choices. That information
then is communicated to the patient allowing
them to clarify and determine their healthcare
options in light of their own values and
preferences.
Health Policy • Shared decision-making evolved from the
• This refers to government efforts to manage recognition of a patient's right to autonomy and
healthcare for the public good. A sound health reflects ethical medical practice
policy should be able to: Social Determinants of Health
➢ assure access to needed healthcare for • In the clinical encounter, patients bring
all
complex social circumstances that are a
➢ incentivize curative research
consequence of their physical and social
➢ protect health quality environment and access to resources.
➢ control healthcare costs Limitations on those resources determine a
Genetics
patient's ability to prevent illness, maintain
• Emerging technologies and knowledge on health, and recover when illness occurs. Social
genetics engender numerous value conflicts. justice draws our attention to disparities in
Bioethics in the age of genomics is challenged health and asks not only that we recognize such
by the increased collection and use of personal disparities it also requires us to actively work
medical and biological information such as toward solutions both for the individual and the
issues of privacy and security. It also challenges population as a whole. Learning about and
the adequacy of traditional conceptions of respecting a patient's socially circumscribed
autonomy, particularly, informed consent.

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access to resources can enhance the patient-
doctor relationship. Even with the expanding
emphasis on genetics and precision medicine, it
remains the case that "it's zip code not genetic
code" - where a person lives as well as their
related social experiences have a profound
impact on their health.
SOME BIOETHICAL ISSUES Whole Genome Sequencing
Abortion
• Being utilized as an essential and invaluable
• Premature ending of a pregnancy occurring procedure in the identification of the order of
spontaneously (miscarriage) or through nitrogenous bases in genes, gene functions, and
surgery, medication or by force is termed their involvement in disease.
abortion. This issues raises intense moral and
• Access to the complete genome of a newborn
personal concerns regarding sexuality,
allows for early determination of the newborn's
autonomy, politics, science, and religion.
predisposition to certain diseases.
• According to the World Health Organization,
• This has raised some of the following bioethical
when women with unwanted pregnancies do
issues, namely:
not have access to safe abortion, they often
➢ the loss of human diversity
resort to unsafe abortion.
➢ serious issues on «designing humans;"
• An abortion is unsafe when it is carried out immense genetic data may be used to
either by a person lacking the necessary skills create new biological weapons
or in an environment that does not conform to ➢ may serve as a foundation for new
minimal medical standards, or both. racism; accessibility may only be for
Characteristics of an unsafe abortion touch those who have the money.
upon inappropriate circumstances before, Cloning
during or after an abortion.
• Refers to the process of creating a new
• Unsafe abortion can lead to immediate health population of genetically similar and identical
risks - including death - as well as long-term naturally occurring organisms. The usual
complications, affecting women's physical and targets for cloning include bacteria, plants, and
mental health and well-being throughout her animals.
life-course. It also has financial implications for
• However, in certain instances, cloning is done
women and communities.
to produce individuals as sources for organs.
Surrogacy
• Cloning is also known as Somatic Cell
• The process of assisting the reproduction of
Nuclear Transfer (SCNT), the technical
parents who are not capable of reproducing or
process by which cloning is performed.
sustaining the development of child inside the
• Bioethical issues that are specific to human
womb. In most cases, surrogacy is carried out
cloning include:
by gestational women or gestational surrogates
➢ the safety and efficacy of the
who are willing to carry and deliver a child for
procedure,
another person or another couple.
➢ cloning for destructive embryonic stem
• Some of the issues brought about by surrogacy
cell research, the effects of
include the following:
reproductive cloning on the
➢ the rights of the children borne out of
child/parent relationship, and the
surrogacy
commodification of human life as a
➢ the ethical and practical complications
research product.
of the commercialization of women's
Genetically Modified Organisms/Genetic
bodies
Engineering
➢ the exploitation of poor and low-
• This is usually done in animals and plant crops
income women desperate for money
which involves transplantation of a gene or a
➢ the moral and ethical consequences of
sequence of DNA of interest from one organism
transforming a normal biological
to another organism to produce the most
function of a woman's body into a
desirable traits.
commercial transaction.
• Altering the genetic make-up of an organism,
using recombinant DNA technology is the
process involved in genetic engineering. Genes
are directly manipulated in order to produce
desired phenotypes.

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• Some bioethical issues involved in genetic desirable traits while controlling and
engineering include: determination and prohibiting the reproduction of populations
establishment of ethical limits, invasiveness of with negative or undesirable traits.
the procedure, unexpected concerns and • Issues concerning eugenics include loss of
potential harm genetic diversity, culturally accepted
Gene Therapy improvement of the gene may lead to
• The modification or manipulation of gene extinction, increased vulnerability to disease,
expression in order to alter the biological reduced ability to adapt to environmental
properties of cells for therapeutic purposes is change and other unanticipated and unexpected
termed gene therapy. A person's gene is consequences.
modified for the purpose of treating or curing a Euthanasia
disease which through replacement of a • Ending the life of an individual to facilitate
disease-causing gene with a healthy copy of the cessation of pain and suffering through
gene; inactivation of a disease-causing gene assisted-suicide or mercy-killing. This is done
that is not functioning properly; and through an act of omission or because of
introduction of a new modified gene into the compassionate motives.
body to help treat a disease. • Issues surrounding euthanasia may include the
• Gene therapy products that are studied to treat availability of proper palliative care that may
cancer, genetic disorders, and other diseases make euthanasia unnecessary, concern on the
include the use of circular DNA molecule that proper regulation of euthanasia, decreased care
are genetically engineered to carry therapeutic for the dying and the terminally-ill due to
genes into human cells (Plasmid DNA), the use euthanasia, and exposure of vulnerable people
of viruses which have the ability to deliver to more pressure to end their lives.
genetic material into cells (Viral Vectors); Organ Donation
modification of bacteria to prevent them from • This is the process of surgically removing a
causing disease and use of these bacteria as tissue or organ from one person (tissue or organ
vehicles to carry therapeutic genes (Bacterial donor) and transplanting it to another person
Vectors), disruption of harmful genes or repair (tissue or organ recipient).
of mutated genes (Human Gene Editing • Some of the issues involving organ donation
Technology), and removal of cells from the include ethics on organ procurement, ethics of
patient and genetic modification of these cells allocation, fundamental morality of organ
through viral vectors and then return of the transplants, possibility of undue influence and
genetically modified cells to the patient coercion, altruism, or commercial dealing,
(Patient-derived Cellular Gene Therapy widening gap between organ supply and organ
Products). demand, and use of living donors as sources of
• Issues involving gene therapy may include the organs.
following: unwanted or unexpected immune Cryonics
system reaction, wrong cells becoming the • Cryonics is reversing the process of death, or
target, infections caused by viral vectors, and only the head part in extremely cold
the high cost of gene therapy. temperatures with the aim of reviving them in
Stem Cell Research and Therapy the future. It involves the method of freezing an
• Use of embryos as sources of undifferentiated individual to reanimate or bring the individual
cells for research and as sources of treatment to back to life in the future.
alleviate human disease and suffering. This is • Cryonics involves the process of preserving
also referred to as regenerative medicine which legally dead human (or animal) body or only its
promotes the repair of disease, dysfunctional or head part in extremely cold temperatures with
injured tissue using stem cells and stem cell the aim of reviving it in the future as and when
derivatives. This procedure makes use of cells appropriate scientific and medical advances
instead of donor organs and may address the become available. It is regarded as a type of
concern involving limited supply of donated conservative medicine which aims to stop body
organs for organ transplantation. functions indefinitely and preserve the cell
• Human embryonic stem cell therapy is a structure and body chemistry by cooling the
controversial bioethical issue because it body at very low temperatures.
involves destruction of human embryos. • Issues concerning cryonics include the person's
Eugenics rights when a person who is considered dead is
• Eugenics works on the possibility of creating a revived in the future, resource allocation, rights
superior human society and race by promoting and dignity of the healthcare team member who
the reproduction of populations with positive or does not agree with cryonics, potential

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possibility of unnecessary suffering on the part and refrain from engaging in any activity that
of a family to move on accept death because of would prejudice their abilities to carry out their
cryonics, and unexpected harm or duties ethically. They shall avoid making any
consequences that cryonics may cause once the representation that would likely cause a
cryopreserved body or body part is revived. reasonable person to misunderstand or to be
PROFESSIONAL ETHICS AND deceived.
PROFESSIONAL CONDUCT Professional Competence
• Professional ethics includes all • In providing professional services, a certain
standards of behavior in one's level of competence is necessary, i.e.,
personal life, in one's occupation, knowledge, technical skills, attitudes, and
and in the workplace. It also experience. Professionals shall, therefore,
encompasses values and guiding undertake only those professional services that
principles established by they can reasonably deliver with professional
professional organizations to help competence. Corollary to this, it is their express
guide professionals in performing obligation to keep up with new knowledge and
their job functions based on sound moral and techniques in their field, continually improve
ethical principles. their skills and upgrade their level of
• Professional conduct involves ethics, morals, competence and take part in a lifelong
and standards of behavior. Being a professional, continuing education program.
it is necessary for the person to maintain his/her Solidarity and Teamwork
ethical behavior and to show good professional • Each profession shall nurture and support one
conduct. organization for all its members. Though a deep
• The terms code of ethics and code of conduct spirit of solidarity, each member should put the
are often mistakenly and interchangeably used, broader interest of the profession above one's
although these are two different and unique personal ambition and preference. Through
documents. Both provide direction to teamwork within a cohesive professional
employees and serve to establish a public image organization, each member shall effectively
of good behavior. However, codes of ethics observe ethical practices and pursue continuing
govern decision making while codes of conduct professional development as well as deepen
govern action. one's social and civic responsibility.
GENERAL PRINCIPLE OF PROFESSIONAL Social and Civic Responsibility
CONDUCT • Professionals shall always carry out their
• Professionals are required not only to have an professional duties with due consideration of
ethical commitment, a personal resolve to act the broader interest of the public. They shall,
ethically, but also have both ethical awareness therefore, serve their clients/employers and the
and ethical competency. public with professional concern and in a
• Ethical awareness refers to the ability to discern manner consistent with their responsibilities to
between right and wrong, while ethical society. As responsible Filipino citizens, they
competency pertains to the ability to engage in shall actively contribute to the attainment of the
sound moral reasoning and consider carefully country's national objectives.
the implications of alternative actions. Global Competitiveness
SPECIFIC PRINCIPLE OF PROFESSIONAL • Every professional shall remain open to
CONDUCT challenges of a more dynamic interconnected
Service to Others world. He or she shall rise up to global
• Professionals are committed to a life of service standards and maintain levels of professional
to others. They protect life, property, and public practices fully aligned with global best
welfare. To serve others, they shall be prepared practices.
for heroic sacrifice and genuine selflessness in Equality of All Professions
carrying out their professional duties even at the • All professionals shall treat their colleagues
expense of personal gain. with respect and shall strive to be fair in their
Integrity and Objectivity dealings with one another. No one group of
• To maintain and broaden public confidence, professionals is superior or above others. All
professionals shall perform their professionals perform an equally important, yet
responsibilities with the highest sense of distinct, service to society. In the eyes of the
integrity and imbued with nationalism and PRC, all professions are equal and, therefore,
spiritual values. In the performance of any everyone shall treat one other professionals
professional service, they shall at all times, with respect and fairness.
main objectivity, be free of conflicts of interest,

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CODE OF ETHICS VS. CODE OF CONDUCT ➢ Take responsibility for carrying out the
CODE OF ETHICS CODE OF CONDUCT duties of their position to the best of
• value statements • applies the Code of their abilities.
• behaves like a Ethics to relevant ➢ Take responsibility for their decisions
constitution situations and for the consequences of their
• provides guidance • outlines specific actions.
about values and behavior that are ➢ In the case of supervisors, take
choices required or prohibited responsibility for assessing the
• affect decision- • affect action performance of staff members in a fair
making • require little and factual manner, in line with agreed
• enable one to make judgement since one objectives.
independent either obeys or incurs ➢ Ensure that the human, financial and
judgement penalty material resources entrusted to them
are used optimally for the benefit of
• wide-ranging and • provides a clear set of
expectations about WHO.
non-specific
which actions are ➢ Record all transactions and prepare
required, acceptable, accurate and complete records, in
or prohibited. accordance with established
Both are used to encourage specific forms of procedures.
➢ Provide advice and guidance to
acceptable and ethical behavior.
colleagues, where appropriate, and
WORLD HEALTH ORGANIZATION (WHO)
exercise adequate supervision and
INTEGRITY
control over tasks they delegate.
• To behave in accordance with ethical
➢ Bear in mind that they speak for WHO
principles, and act in good faith, intellectual
when speaking to the media on subjects
honesty, and fairness
within their area of responsibility and
• WHO staff members are expected to: expertise, ask for permission from their
➢ Observe national and local laws at all supervisor and seek advice from WHO
times. Communications Officers as
➢ Avoid any action that could be appropriate.
perceived as an abuse of privileges and INDEPENDENCE AND IMPARTIALITY
immunities.
• To conduct oneself with the interests of WHO
➢ Demonstrate the same standards of
only in view and under the sole authority of the
integrity in their personal pursuits as
Director- General, and to ensure that personal
they do in the workplace.
views and convictions do not compromise
➢ Never engage in any level of physical
ethical principles, official duties or the interests
or verbal violence or threat of violence.
of WHO
➢ Demonstrate the highest standards of
• WHO staff members are expected to:
scientific integrity as public health
➢ Disclose promptly and fully any
practitioners and/or researchers.
conflict of interest or potential situation
➢ Protect the security of any confidential
of conflict of interest through a form of
information provided to, or generated
declaration of interest or by seeking
by, WHO.
advice from the Ethics team in the
➢ Report suspected wrongdoing or
Office of Compliance, Risk and Ethics
breaches of WHO ethical principles,
on a confidential basis. Or staff may
rules, regulations or policy through
consult their supervisor as applicable
established mechanisms (Integrity
concerning the appropriate action,
Hotline).
including possible recusal.
➢ Demonstrate the same discretion and
➢ Refrain from seeking or obtaining,
prudence in their professional and
under any circumstance, instructions or
private communications, emails or
undue assistance from any government
social media activities.
official or from any other authority
ACCOUNTABILITY
external to the Organization.
• To take responsibility for one's actions,
➢ Exercise discretion at all times in their
decisions and their consequences
personal political activities and in
• WHO staff members are expected to: expressing their personal opinions and
➢ Define clear and realistic objectives beliefs.
and deliverables for their activities in ➢ Ensure that any external experts and/or
consultation with their supervisors. non-staff members with whom they

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collaborate complete declarations of PROFESSIONAL COMMITMENT
interest forms and review them • To demonstrate a high level of professionalism
systematically, consulting the Ethics and loyalty to the Organization, its mandate,
team for advice, and take responsibility and objectives.
for the final decision concerning their • WHO staff members are expected to:
involvement with WHO. ➢ Deliver on the duties of their position
➢ Bring any intimate relationship with in an ethical and professional manner.
another WHO staff member or other ➢ Keep in mind the longer-term
collaborator to the attention of their objectives of WHO when managing
supervisor, Department of Human short and medium term activities or
Resources or the Office of Compliance, operations.
Risk and Ethics (CRE) if there is a ➢ Follow professional developments in
supervisory relationship between them. their domain of activity to maintain
➢ Seek written permission from their excellent technical standards.
supervisor and the CRE before ➢ Use their professional expertise
committing to any outside activity. constructively for the benefit of WHO.
➢ Decline gifts whose value is in excess ➢ Uphold and promote the standards of
of US$100, unless it would cause their professional codes of conduct.
embarrassment to refuse, in which case ➢ Demonstrate openness to new ideas
they must declare them to CRE. and approaches and favor new thoughts
➢ Seek authorization from the Director- and concepts.
General or the Regional Director,
through CRE before accepting any
decoration or honor.
➢ Resign prior to initiating a political
campaign or a nomination process.
RESPECT
• To respect the dignity, worth, equality,
diversity and privacy of all persons
• WHO staff members are expected to:
➢ Respect and value differences.
➢ Treat others with tact, courtesy and
respect.
➢ Demonstrate awareness that statements
or actions not necessarily intended to
be offensive to another person may be
perceived as such by exercising
restraint and refraining from
unpleasant or disparaging remarks or
actions.
➢ Maintain a professional environment
characterized by good working
relations and an atmosphere of courtesy
and mutual respect.
➢ Abstain from and actively discourage
all forms of harassment, including
verbal, nonverbal, written or physical
abuse.
➢ Never engage in acts of sexual
harassment, and report any they
become aware of.
➢ Never engage in acts of sexual
exploitation and abuse and report any
they become aware of.
➢ Refrain from engaging in gossip.
➢ Never report erroneous facts in bad
faith.

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