Learning Module 2

Ethical Theories and Principles and

the Role of Religion in Ethics

Learning Packet 4

Basic Moral Principles

Written by:

MARITES F. PASCUAL , BPSU

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Learning Packet 4

Basic Moral Principles

Introduction
Aside from Ethical theories we had just discussed, Moral principles are set of
guidelines that we need to know and understand so that our decisions and actions are
geared towards what is right and avoid what is wrong (Rich,2012). They serve as
foundations for moral decision-making and doing and the end goals in regulating moral
actions. All moral actions must begin and end through Moral Principles. With the help
of the ethical theories on previous packets, you are expected to utilize these principles
not only in the class but also in all the facets of your moral life.
In this packet we will discuss the Four Basic Bioethical Principles such as
Autonomy, Beneficence, Non-Maleficence and Justice. Other principles such as
veracity, confidentiality and consent will come into play when these principles are
applied in certain situations. Bioethics is a branch of applied ethics in the study and
exercise of Medicine and other related fields. However, we will position our selves to
the idea that these basic moral principles are ordinary life lessons as well as we are
supposed to respect others’ freedom (autonomy), do good (beneficence) and avoid
doing harm (non-maleficence) to them and give what is due them (justice) as members
of a moral community and as beings for others and the world. In the end, we hope to
realize that these principles are there all along to guide us. But it must be reconsidered,
be studied and be enriched all the more when things get more completed especially
when big decisions have to be made.

Objectives
1. Define moral principles.
2. Cite examples or situations how the principles are applied.
3.. Apply Basic Moral Principles outside bioethical situations.

Learning Management System

Readings, lectures, video tutorials, and other resources are the basic learning
materials for this course, and they can be accessed through our Google
Classroom. Online meetings are via Google Meet.

Duration

• Topic 04: Basic Moral Principles = 3 hours (2 hours self-directed learning

with practical exercises and 1 hour assessment)

Delivery Mode
Synchronous and asynchronous

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Assessment with Rubrics

. Subjective type activities and assessments will be evaluated using rubrics (see
annex). To each essay type activities, you answer I will be looking for what I call the
4X’s of evidence of learning. The 4Xs stand for EXPLAIN, EXPOUND, EXAMPLE
and EXPERIENCE.). To EXPLAIN means you have to elaborate on the important
terms found from the lesson. To EXPOUND means to contribute to these key terms
either from your previous knowledge or searched ideas that will improve your
understanding of the topic. To concretize your learnings, you are advised to give
Examples related to the ideas found from the key terms. It is highly recommended that
your examples are based on your own EXPERIENCES, if possible, as long as it is
related and will solidify your argument in the topic being discussed.

Requirement with Rubrics

For this packet you are entitled to write a short reaction paper from a YouTube
video entitled Coma Patient Unexpectedly Found Pregnant | Chicago Med through this
link https://www.youtube.com/watch?v=pPe_bEyfC-A. On your paper, focus on how
the Moral Principles are applied and observe how they are interplayed in Bioethical
field. State the particular scenes that you think the principles are used and make a
general statement of your observation. (See Annexes for rubrics)
Follow these specifications:
12 Font Size, Times New Roman
1.5 Spacing, 1 inch Margin on all sides.
Minimum of 500 words.

Readings

The following are readings that may help you to prepare in the lesson proper.

1. Introduction to Bioethics and Ethical Decision Making by: Karen L.

Rich(2015) JP Pub, 9781284077223_CH02_033_070.indd 33.
http://samples.jbpub.com/9781284059502/chapter_2_sample.pdf
2. Bioethical Principles and Clinical Decision Making by Candice S. Rettie and
Randall S. Burd. http://eknygos.lsmuni.lt/springer/252/149-158.pdf

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Pre-Assessment
MULTIPLE CHOICE, Write the letter of the correct answer on the space
provided before the number.

_____1. This principle entitles everyone to be informed first of his/her options

and the possible consequences to come up with a responsible choice especially
in situations thar are beyond his/her own capacity
a. Autonomy b. Beneficence
a. Justice d. Non Maleficence

_____2. It refers to everyone having an equal opportunity. This principle seeks

to eliminate discrimination. It obliges us to give what is due to the person.
a. Equality b. Retributive
c. Justice d. Distributive

______3. This principle obliges everyone to tell the truth.

a. Equality b. Confidentiality
c. Equity d. Veracity

_____4. Primum Non- Nocere means:

a. Do good , avoid evil b.. First of all, Do no harm
c. Do good, avoid harm d. Do not do harm

_____5. The guiding principle used in cases that requires action with foreseeable
good and bad effect/s.
a. Double Effect b. Double Jeopardy
c. Double Autonomy d. Double Justice

_____6. The principle that ensures patients that any medical information is
secured and no one has the right access without proper consent.
a. Autonomy b. .Beneficence
c. Confidence d. Confidentiality

_____7. The principle that entitles the person of self-determination and make
well-informed decisions.

a. Autonomy b.. Beneficence

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a. Justice d. Non-Maleficence

_____8. The principle that allows the patient to permit medical procedures to
him/her provided that he/she is informed of conditions and possibilities.
a. Consent b. Confidentiality
c. Double Effect d. Justice

_____9. The following are conditions for Principle of Double Effect except for
one:
a. Good Intention of the Doer.
b. The Act is morally good or at least neutral.
c. Bad means must cause good ends.
d. The positive effect outweighs the negative effects.

_____10. The principle that obliges everyone to remember doing good always at
all times,
a. Autonomy b.. Beneficence
c. Justice d. Non-Maleficence

Lesson Proper
Review
Watch the YouTube video entitled Mandatory vaccinations: Human
Rights vs. Public Health? located in this link
https://www.youtube.com/watch?v=TwDfOQMXcxE . Share your thoughts about
social justice using John Rawls’ Theory of Justice or other types of justice
discussed from the last packet by answering the following questions:

1. Should vaccinations become mandatory? Explain

2. Does mandated vaccination reflects social justice? Explain.
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Activity.
Write some of your parents’ or guardians’ “bilin”, “sermon” o “pangaral”
and write the possible reasons or underlying principles why they always remind
us of these life lessons.

“Bilin” / “Sermon”/ “Pangaral” Possible Underlying Principle or

Reason
1.

2.

3.

4.

5.

Processing of the Activity.

Every move we make lies reason and purpose. Deep within these reasons
and purposes are guiding principles that each of us value or believe to be our rule
of life. Our parents must have a lot of “bilin”, “pangaral” o “sermon” because
they want us to be good, spare ourselves of being hurt or inflicting harm on
others, and with an upright moral grounding, we may transfer that goodness to
others as we respect and acknowledge their personhood. In this course packet,
we will explore principles in the context of moral actions and how these moral
principles can be applied in all situations of our moral life.

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Discussion Proper

Basic Moral Principles of Everyday Life

Every moral action, even if you are unconscious of it, lies guiding
principles where you can base the moral judgement of your action. It is not that
you do not know them because I believe these principles were taught to us
already by our parents, teachers or someone who has become your moral
exemplar. It is basic for us that we should avoid harming others, do good to them,
and respect (the first act of justice) their autonomy. You might here others saying
“huwag mong gawin yan!”, “eto ang gawin mo!”, “respeto naman!” and the
famous “huwag mo kong pakialaman!”. These are the seeds of 4 basic moral
principles implanted and impressed on you at the early stages of your life. As
you get old, you realize that things are not as easy as 123 or life’s realities
pictured as black and white. In the most difficult stages of our life, particularly
those that concerns morality, we are confronted of situations that needs deeper
discernment. Sometimes, we face the uncertainty of not knowing whether our
actions are good or bad especially in situations that we are alone and we have to
decide. But in the end, with moral courage and developed moral dispositions, we
keep coming back to these basic moral principles, stand by it, and work out our
decisions along the lines of these precepts.
“Huwag mong gawin yan!” If our parents tell this to us, one of the reasons
is to stop us from getting hurt or because we might hurt others too. As a basic
moral principle, we are trained to “do no harm” to our self and others. This is the
principle of non-maleficence (obligation not to harm). It is an obligation not to
inflict harm intentionally This principle stands for many things, including
dedication, loyalty, truthfulness, advocacy, and fairness to everyone. This
reminds us that one of our first considerations for moral action is to avoid
inflicting harm, Primum Non-Nocere so to speak in Latin. If you do not intend
to do good, please, for the very least, do not intend to harm anyone including
yourself.
“Eto ang gawin mo!” can be an order, suggestion or recommendation
and reflects goodwill from someone. Often, elders tell us what to do thinking
that it is proven or to be good or foreseeably at least. Things like this build the
principle of beneficence in us. It states that one must provide benefits to
persons and contribute to their welfare. While non-maleficence prevents one
from doing harm (which at times more beneficent), this principle compels
everyone to do good always.

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Autonomy (individuals have a right to self-determination) (self-law) It

means that individuals have a right to self-governance and self-determination
(Varkey,2020). This is in consideration to one’s ability to make free and
responsible choices. Though it sounds negative, we hear at times the phrase
“Huwag mo kong pakialaman” from people who does not want somebody to
interfere with his/her decisions. Impressed on the phrase is the autonomy of the
person to govern himself/herself and that we have to respect such decisions out
of his/her exercise of freedom. But unlike the phrase above, the principle of
autonomy entitles everyone to be informed first of his/her options and the
possible consequences to come up with a responsible choice especially in
situations especially in areas that are beyond his/her own capacity. This
reminds us that while there are times that somebody would say to us what is good
or bad and what you should do or avoid, in the end, it is our own self-governing
capacity to make a choice that will define the course of actions we are to take
after options that are factual and true are presented to us.
Another important principle is Justice (equality and equity). The
principle of justice can almost be summed up in the word 'equal'. It refers to
everyone having an equal opportunity. This principle seeks to eliminate
discrimination. It obliges us to give what is due to the person. Often, giving what
is due does not begin in allocation of stuff (distributive) and avenge or get even
to the harm done (Retributive) but in giving respect to the personhood of the
other. Respect is the prime mover of Justice (Dillon,2021). So whenever you
hear “respeto naman!”, you are being reminded that the first ever thing that you
have to give what is due to the other is “respect”. In context, the phrase is a
sarcastic way of saying the lack of respect of the person to the other which in
one word in Filipino “bastos”. So, if one respects the other, then he/she knows
what the other deserves or due to them. This is where the other types or forms of
justice comes in. Depending on the situation, giving what is due could be in a
form of equality or equity in terms of distributive justice or retributive and
restorative in Criminal justice (CrashCourse,2016).

Basic Bioethical Principles

One may recognize that these 4 principles are in harmony with each
other. Beginning with Justice, out of respect, you will do no harm and do good
to others while realizing that the other is an autonomous person like you.
Whenever you are with friends, family, relatives, work or every where in the
community, these four principles ensure order if every body applies them. You
respect everyone, you do good to them and avoid inflicting harm and recognize
their independence. But there is a place where almost every day, it is ordinary

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that some of the principles are conflicting and that careful analysis must be done
in order to come up with a life-saving ethical decision. These basic moral
principles are being applied in bioethical fields on a different level compared to
our ordinary days. Bioethics is a branch of ethics where ethical theories and
principles are applied in medicine and other related fields of life sciences
(Chadwick,2019). This is where also these principles are conflicting and
contradicting one another that often spark debate among ethicists. To put
everything in context, consider reading the case below and observe how the four
principles are applied. Eventually, we will include other principles as they might
be necessary in figuring out the next moral actions that needs to be done.

Case 1. A sixteen-year-old male member of Jehovah's

Witnesses incurred injuries in an auto accident. The injuries
required surgery. He had informed both ambulance personnel
and the hospital of his wish not to receive blood transfusions.
Surgery was performed without use of blood transfusions.
Frequent blood tests revealed steadily declining
hemoglobin and hematocrit readings. Physicians attempted to
persuade patient and his mother (divorced, with custody of her
son) to consent to blood transfusion, but they resolutely
declined. After the surgeon expressed his opinion that patient
was in imminent danger of life-threatening consequences, legal
counsel for the hospital filed a late afternoon petition in the state
court for appointment of a guardian ad litem, without notice to
either the patient or his mother. On same evening, informal
hearing was held by the state judge, attended by only the
hospital's risk manager and two hospital attorneys. The state
judge appointed guardian ad litem.
The following morning, the state judge was told by the
risk manager that the patient's condition had deteriorated more
during the night. The judge directed that a further hearing be
held forthwith at the hospital, and directed who should be
present (did not specify either patient or his mother, and neither
attended or was consulted). Surgeon and a second treating
physician testified to medical need for transfusion. State judge,
at guardian ad litem's request, entered order permitting
transfusion. Patient was physically restrained and transfused
with three units of packed red blood cells, on afternoon of day
of the hearing and order.
Patient recovered, without adverse physical reaction
from the transfusion, and was discharged one and one-half
months later. (Excerpted from The Case of Jehovah’s Witness:
A Minor Requiring Blood Products, Center for Applied
Bioethics,2021)

You might focus on the seemingly happy ending of the story but upon careful
analysis, there are conflicting moral principles present which left the doctor on

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a “what must be done” situation. Principles of Beneficence and Non-

Maleficence would tell us that the physicians have to minimize the risk and
maximize benefits as they perform necessary procedure to save the life of a
teenager. However, being a member of a religious denomination that refuses
blood transfusion is a serious case. With a guardian’s refusal for blood
transfusion and a time running out to her son’s life, the doctors are compelled to
make a decision that someone must be appointed as “guardian ad litem”, a
“guardian appointed by the court to represent the interests of Infants, the
unborn, or incompetent persons in legal actions” (West’s Encyclopedia of
American Law, 2008). In this case, the autonomy of the patient and the mother
is violated and the principle of respect of persons which is also connected to
justice is also being questioned because their beliefs are discredited. But have
not the doctors intervened; the boy could be dead. However, in the mind of a
member of Jehovah’s Witnesses, they better die obeying than survive but lose
eternal salvation (Gillon on McKlean,2003).

Other Bioethical Principles

Cases or moral dilemmas like this seem to make the four basic moral
principles not enough to solve the problem. And so in some instances other
principles might be taken into consideration. You might not notice that the
principles of veracity and consent were applied when the doctors told the
patient and his guardian the possible procedures and options so that they can
make an educated decision so as to exercise their autonomy well and allow them
(the physicians) to proceed. By definition, veracity principle is the duty to tell
the truth and consent is a sort of agreement between parties where one is allowing
the other to make something happen (Varkey,2020). Physicians must take into
account the requirements of an informed consent for a medical or surgical
procedure, or for research, are that the patient or subject “(i) must be competent
to understand and decide, (ii) receives a full disclosure, (iii) comprehends the
disclosure, (iv) acts voluntarily, and (v) consents to the proposed action” (p.19).
Another governing principle in bioethical field is the principle of
confidentiality which respects the privacy of the person. In this case, the patient
is assured that no one can access to the medical information especially the
sensitive ones or whatever had transpired in the agreement between parties
unless there is a compelling reason to do so (p.20)

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Principle of Double Effect

When things get messier in the hospitals or even in other fields and areas of
our lives, we will come across dilemmas to which any course of action will have
its good and bad effect at the same time. In cases like this, one must adhere to
the principle of double effect (PDE) to guide the possible course of actions to be
made. This principle was first developed by Thomas Aquinas under Catholic
Moral Theology. He specified four conditions for an act to be ethically justified;
First, the nature of the act itself is good or at least neutral/ indifferent. Second,
the intention of the doer must be good even if the bad effect is imminent or
foreseeable. Third condition, the bad effect must not be the means to achieve the
good effect. Even if the good means would cause bad effect, it must not be that
the bad means (or effect) would cause the good effect. Lastly, the good effect
must outweigh the bad effect (Schwartz on Quirindongo, (2013). Consider the
case of a woman with ectopic pregnancy:

Case 2. In ectopic pregnancy, the embryo implants

outside the uterine cavity, most often in one of the
Fallopian tubes, and needs to be removed as soon as
possible. An untreated ectopic pregnancy can lead to
rupture of the tube and likely death of the pregnant
woman. In fact, complications from ectopic pregnancies
are the leading cause of maternal death in the first
trimester.
Excerpted from Explained: Double Effect, Ectopic
Pregnancy, and Methotrexate, Doctors for
Choice,Mata,2020)

Currently, the accepted procedure is to cut the fallopian tube where the embryo
has developed. This will eventually kill the embryo but under the principle of
double effect, this is morally permissible for it has satisfied the four conditions:

1. Removing a part of the body that is about to rupture and cause

the death of the individual is a morally good action.
2. The death of the embryo is not direct intention of the procedure.
3. The death of the embryo is not willed and would be avoided if at
all possible.
4. The life of the mother is considered equal to the life of the
embryo in Catholic doctrine. (Doctors Choice,2020).
Although it has gained criticisms in recent years along with its praises, the
PDE remains to be a strong principle in justifying actions in such related
situations. Anyone who is in the difficult situation, that is, the possibility of
inflicting harm to others to promote a good end must weigh all possibilities and
consequences to achieve the desired outcome and that, the sacrifice, if needed

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be, justifies the fourth condition of this principle (McIntyre, 2019).

Enhancement Activity.

Discern the following situations and discuss what is the best possible principle
that needs to be applied or you think violated. Explain and justify your answers
clearly and briefly.

Case 1. “Teenage Pregnancy”

A 14-year-old accompanied by her mother presents with complaints of
nausea and vomiting for two weeks. After her mother leaves the room,
she admits to being sexually active and tells you that she has had
unprotected intercourse recently with her boyfriend and missed a
period. Her parents do not know she is sexually active, and she does
not want her mother to know that a pregnancy test is being done or the
result of that test. Pregnancy test comes back positive. (Excerpted from
Seatle’s Children,2021)

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Case 2: “Marawi Seige”

The team where Bayot belonged to was attacked on the second day
of the Marawi siege. It was said that some of the private security men
and bodyguards of the mayor ‘helped’ the Maute terrorists to assault
Bayot’s team and get inside the guarded house. They radioed for backup
and reinforcement, but it was too late because the only way to get to their
position is to go through the passage full of enemies. Hours later, the
PFC’s five comrades were already dead, leaving him alone in his area.
He again tried to contact their commanding officer, but instead of asking
for reinforcement, he startled the rescue team with this request:
“Bombahin na lang ninyo ang location ko, Sir! (Just bomb my location,
Sir!)" (Excerpted from “Just Bomb My Location, Sir!”by Sharmaine
Alilin, https://www.apc.edu.ph/just-bomb-my-location-sir/)

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Case 3: “Deposito”
Manila, Philippines – Pinirmahan na ni Pangulong Rodrigo Duterte ang
batas na magpapatupad ng mas istriktong parusa sa mga pagamutan na
tumatanggi sa mga pasyenteng walang pang-deposito.
Inamyendahan ng Republic Act. no. 1-0-9-3-2 ang batas pambansa
bilang 7-0-2, na mas kilala bilang “An Act Prohibiting the Demand of
Deposits or Advance Payments for the Confinement or Treatment of
Patients in Hospitals and Medical Clinics in Certain Cases,”.
Sa ilalim ng bagong batas, maaring mapatawan ng parusang
pagkakalulong nang hindi bababa sa anim na buwan pero hindi lalagpas
sa dalawang taon at apat na buwan ang sinumang medical practitioner
o empleyado ng ospital o clinic na lalabag sa mga probisyon
nito.(Excerpted from RMNEWS, Aug.5,2017, https://rmn.ph/batas-na-
magpaparusa-sa-mga-ospital-na-tumatanggi-sa-pasyenteng-walang-
pang-deposito-mas-hinigpitan-na/)
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Case 4. “Trolls being paid”

In the age of social media, "trolls" or persons paid to make multiple
fake accounts to promote a client have become part of the online
community, influencing how the other netizens think and react on certain
issues.
In an episode of GMA News TV's Brigada featuring Fact or Fake
with Joseph Morong, a troll army leader shared how the trade works for
their 500-strong group that earns from online activities.
"We’re pushing the candidate. Marami kaming services, boosting,

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defense, fortify, we don’t really do negative – ibang operation iyon. But

this is the good one," said Don (not his true name), head of a group of
trolls.The chain of command in the troll farm starts with the political
clients. They set the narrative that they want to disseminate and the head
of the public relations team takes note of it….( Excerpted from PHL
online troll earns between P30,000-P70,000 a month, leader bares
Dona Magsino, GMA News, Feb.27,2019)

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Case 5. “Small wounds could kill”

One day, a patient comes to see her complaining of ankle pain on
his right leg. The patient is a farmer and says that he fell while he was
taking care of his chickens in the chicken coup. He has some cuts and
bruises on either leg, complains of a swollen right ankle, but appears to
be fine otherwise. Dr. Contadina instructs him to purchase an air cast at
a pharmacy along with some ibuprofen and to take it easy. Dr. Contadina
returns to seeing other patients and Joe goes home.
Three days later Joe is admitted to the emergency room. He has
low blood pressure, a fever, extreme shaking, an irregular heartbeat, and
is very agitated. After removal of the air cast, the nurses notice a cut that
has become infected on his left leg (the opposite of the leg with the
swollen ankle). Joe’s condition continues to worsen and he eventually
goes into Septic shock. After two days in the ICU, Joe dies of complete
organ failure.
The family wants answers, and so far all they know is that he
came in with one small cut and suddenly died. The hospital is pressuring
Dr. Contadina to apologize in hopes of mitigating some legal trouble. Dr.
Contadina is afraid that if she admits that there was any chance she made
a mistake, that she’ll be in bigger trouble- both legally and
professionally. She is very afraid of what her colleagues and patients will
think if she admits that she made an error. (Excerpted from One Small
Cut that Killed, Lindsay Bohonik, Practical Bioethics
https://www.practicalbioethics.org/case-studies-one-small-cut-that-
killed.html )

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Generalization

It's important that you align your actions and words with your moral
principles because it helps us to live a morally upright life. These principles will
also your weapons when great challenges of life come. When these situations
arrive, it matters also that we have to discern well. We have to analyze details of
every case so that we can create possible ethical solutions. Along with the object,
intention and circumstance of a situation, there will be theories as well as
principles that will help us come up with moral course of action. On the next
course module, all of these you will have to use to propose solutions for every
moral dilemma.

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Application

Share some of your experiences that you remember applying the following moral
principles:

Basic Moral Principle Related Experience

1. Beneficence/Non-Maleficence

2. Autonomy

3. Double Effect

4. Veracity

5.Confidentiality

Learning Packet Discussion Forum

Create groups with 5 members each and discuss the case from the article
Explained: Double Effect, Ectopic Pregnancy, and Methotrexate
(.https://www.doctorsforchoice.mt/post/explained-double-effect-ectopic-
pregnancy-and-methotrexate.) Decide whether using Methotrexate to treat
ectopic pregnancy moral or immoral. Be able to justify your answer. Write a
summary of your discussion and prepare to present it in our online discussion.

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Post-Assessment
TRUE OR FALSE: Write T if the statement is TRUE. If the statement is FALSE,
write the correct answer on the space provided before the number.

_____1. The principle of autonomy ensures patients that any medical information is
secured and no one has the right access without proper consent

_____2. In the principle of double effect, the good effect must outweigh the negative
.

______3. The principle of confidentiality allows the patient to permit, withhold or deny
medical procedures to him/her provided that he/she is informed of conditions and
possibilities

_____4. The principle of beneficence adheres to the idea that no one should inflict harm
to others.

_____5. The principle of good effect is being used in cases that requires action with
foreseeable good and bad effect/s.

_____6. Principle of Autonomy refers to everyone having an equal opportunity. This

principle seeks to eliminate discrimination. It obliges us to give what is due to the
person.

_____7. The principle of anatomy entitles the person of self-determination and make
well-informed decisions.

_____8. This principle of veritate obliges everyone to tell the truth and inform patients
with truthful and factual options.

_____9. The principle of justice entitles the patient to be informed first before
permitting physicians to continue any medical procedures.
.
_____10. Principle of Non-Maleficence obliges everyone to remember doing good
always at all times,

***End of Course Packet***

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References

Bunkle, Philida, (2018) A response to Primum non nocere: rst do no harm NZMJ 27
July 2018, Vol 131 No 1479 ISSN 1175-8716 © NZMA www.nzma.org.nz/journal

Chadwick, R. Felicity (2019, May 27). Bioethics. Encyclopedia Britannica.

https://www.britannica.com/topic/bioethics

Cobb, Novak, V. () The Case of Jehovah’s Witness: A Minor Requiring Blood

Products , Center for Practical Bioethics. https://practicalbioethics.org/9-
uncategorised/587-case-study-a-minor-requiring-blood-products.html

Dillon, Robin S., "Respect", The Stanford Encyclopedia of Philosophy (Summer 2021
Edition), Edward N. Zalta (ed.), URL =
<https://plato.stanford.edu/archives/sum2021/entries/respect/>.

Explained: Double Effect, Ectopic Pregnancy, and Methotrexate. Doctors for Choice.
https://www.doctorsforchoice.mt/post/explained-double-effect-ectopic-pregnancy-
and-methotrexate

guardian ad litem. (n.d.) West's Encyclopedia of American Law, edition 2. (2008).

Retrieved September 5 2021 from https://legal-
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