A patient’s age serves as a very useful guide to physicians in deciding what disease manifestations to anticipate, what treatment to offer for certain conditions, and how to prepare for possible emergencies. In the context of the COVID-19 pandemic, determining treatment options on the basis of a patient’s chronological age can easily give rise to unjustified discrimination. This is of particular significance in situations where the allocation of scarce critical care resources could have a direct impact on who will live (...) and who will die. This paper examines the fairness of recommendations contained in resource allocation guidelines in the Philippines that have implications for the way elderly patients could be treated or excluded from some forms of critical care treatment in the context of the ongoing Corona virus emergency. (shrink)

Relatively subtle forms of exploitation of human subjects may arise from the inefficiency or incompetence of a researcher, from the existence of a power imbalance between principal and subject, or from the uneven distribution of research risks among various segments of the population. A powerful and knowledgeable person (or institution) may perpetrate the exploitation of an unempowered and ignorant individual even without intending to. There is an ethical burden on the former to protect the interests of the vulnerable. Excessive or (...) insufficient compensation may be exploitative. However, genuine economic imperatives motivating needy volunteers have to be considered. These forms of exploitation should be appreciated in the context of social and cultural factors suggesting that the relationship between researcher and subject cannot properly be appraised as a contractual undertaking. While compliance with pertinent codes and regulations minimises the exploitative potential, they cannot be enforced in a way that does not recognise a society's peculiar characteristics. The experience with some Filipino cultural traits illustrates this point. (shrink)

The Philippine government officially responded to the Declaration of Istanbul on Organ Trafficking and the related WHO Guidelines on organ transplantation by prohibiting all transplants to foreigners using Filipino organs. However, local tourists have escaped the regulatory radar, leaving a very wide gap in efforts against human trafficking and transplant tourism. Authorities need to deal with the situation seriously, at a minimum, by issuing clear procedures for verifying declarations of kinship or emotional bonds between donors and recipients. Foreigners who come (...) to the country for transplants with same-nationality donors constitute a problem that is replicated in many transplant centers around the world. Also, emotionally related living donors continue to pose challenges for ethics committees, especially because of the realities associated with the existence of extended families. Those who find themselves facing these issues need to be armed with clear protocols for going through the process of verifying documents and individual declarations assiduously. There is also a need for international referral mechanisms at least to ensure that governments are aware when their citizens travel for transplant so they can take steps they consider suitable to address the vulnerabilities of exploited persons. (shrink)

A debt of good will is incurred when a person becomes the beneficiary of significant assistance or favor given by another. Usually, the beneficiary is in acute need of the assistance given or favor granted. This provides an opportunity for the giving of help to serve as a vehicle for the expression of sympathy or concern. The debt could then be appreciated as one of good will because, by catering to another person's pressing need, the benefactor is able to express (...) positive dispositions towards the beneficiary. It is not merely the receipt of the assistance or favor that puts the recipient in a position of indebtedness. The indebtedness is created by the benefactor's kagandahang loob. An act can be considered to convey kagandahang loob only if it is done out of kusang loob ; and can only be considered to have been done out of kusang loob if the agent is not acting under external compulsion, is motivated by positive feelings towards the beneficiary, and is not motivated by the anticipation of reward. These conditions entail debt-of-goodwill relationships where the benefactor has no right to demand reciprocity but the beneficiary has a "self-imposed" obligation to repay kagandahang loob with kagandahang loob. Debts of good will are about some forms of justice. But we should not reduce all talk about debts of good will to talk about justice. (shrink)

Practical medical decisions are closely integrated with ethical and religious beliefs in the Philippines. This is shown in a survey of Filipino physicians' attitudes towards severely compromised neonates. This is also the reason why the ethical analysis of critical care practices must be situated within the context of local culture. Kagandahang loob and kusang loob are indigenous Filipino ethical concepts that provide a framework for the analysis of several critical care practices. The practice of taking-from-the-rich-to-give-to-the-poor in public hospitals is not (...) compatible with these concepts. The legislated definition of death and other aspects of the Philippine Law on Organ Transplants also fail to be compatible with these concepts. Many ethical issues that arise in a critical care setting have their roots outside the seemingly isolated clinical setting. Critical care need not apply only to individuals in a serious clinical condition. Vulnerable populations require critical attention because potent threats to their lives exist in the water that they drink and the air that they breathe. We cannot ignore these threa ts even as we move inevitably towards a technologically dependent, highly commercialized approach to health management. (shrink)

This article discusses the establishment of a governance framework for biomedical research in Singapore. It focuses on the work of the Bioethics Advisory Committee , which has been instrumental in institutionalizing a governance framework, through the provision of recommendations to the government, and through the coordination of efforts among government agencies. However, developing capabilities in biomedical sciences presents challenges that are qualitatively different from those of past technologies. The state has a greater role to play in balancing conflicting and potentially (...) irreconcilable economic, social, and political goals. This article analyzes the various ways by which the BAC has facilitated this. (shrink)

This essay reexamines the four-principle approach to biomedical ethics in the context of ethics education in general and in relation to possible ethics discourse within a community of inquiry in particular. A community of inquiry is the setting for learning and education in philosophy for children. This community enables children to acquire critical thinking and other skills as part of democratic education. The use of the four principles approach tends to contribute to a practice that limits critical thinking skills because (...) of the constraints on the conceptual tools that tend to be used. It has also had the effect of promoting conceptual ambiguity by encouraging the use of limited conceptual molds, thus giving rise to the possibility of multiple interpretations among diverse users, especially in the field of global bioethics. While recognizing the continuing appeal of the approach as a conceptual tool for ethical decision-making the essay brings out the limitations that need to be overcome in order to promote the clarity that the four principles approach is meant to possess. (shrink)

Fast food companies like Siam Burger that participate in health awareness campaigns create a conflict of interest between the social responsibility of promoting health and the business interest of increasing sales through marketing strategies like advertising. Alternative options of raising health awareness without mitigating the involvement of fast food companies either by denying advertisements or having a third party foundation should be explored.

The offer of the fast food company gives rise to suspicion. This seems to be based on unfounded stereotypes, however. This paper argues that we need to preserve choices in taking particular courses of action. There is nothing inherently wrong in fast food consumption so long as consumers are made aware of the importance of weight management and proper nutrition.