BIOETHICAL PRINCIPLES

Bioethical Principles

 

A.      PRINCIPLE OF AUTONOMY

Personal liberty of action in which the individual determines his/her own course of action in accordance with a plan chosen by him/herself; self determination. Implies independence and self-reliance, freedom of choice, and ability to make decisions. Cannot exist in a vacuum but must be acknowledged and respected by others.

 
B.      PRINCIPLE OF NON-MALEFICENCE

 
Do no harm. Includes:

* Deliberate harm - - always impermissible

* Risk of harm - - what degree of risk is permissible?

* Harm that occurs during performance of beneficial acts.

 
C.       PRINCIPLE OF BENEFICENCE

The duty to help others further their important and legitimate interests when we can do so with minimal risk to ourselves. Includes:

* The duty to confer benefits and actively to prevent and remove harm.

* The duty to balance the good it is possible to produce against the harm that might result from doing or not doing the good.

 
D.      PRINCIPLE OF JUSTICE

The duty to give to the other what that person is due or owed, what he/she deserves or can legitimately claim. Involves rights or claims that must be balanced against each other.

The commonly accepted principles of health care ethics include: the principle of respect for autonomy, the principle of nonmaleficence, the principle of beneficence, and the principle of justice. 1. Respect for Autonomy  Any notion of moral decision making assumes that rational agents are involved in making informed and voluntary decisions. In health care decisions, our respect for the autonomy of the patient would, in common parlance, mean that the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act. This principle is the basis for the practice of "informed consent" in the physician/patient transaction regarding health care.

2. The Principle of Nonmaleficence The principle of nonmaleficence requires of us that we not intentionally create a needless harm or injury to the patient, either through acts of commission or omission. In common language, we consider it negligence if one imposes a careless or unreasonable risk of harm upon another. Providing a proper standard of care that avoids or minimizes the risk of harm is supported not only by our commonly held moral convictions, but by the laws of society as well. In a professional model of care one may be morally and legally blameworthy if one fails to meet the standards of due care. The legal criteria for determining negligence are as follows: the professional must have a duty to the affected party the professional must breach that duty the affected party must experience a harm; and the harm must be caused by the breach of duty. This principle affirms the need for medical competence. It is clear that medical mistakes occur, however, this principle articulates a fundamental commitment on the part of health care professionals to protect their patients from harm.

3. The Principle of Beneficence   The ordinary meaning of this principle is the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient. These duties are viewed as self-evident and are widely accepted as the proper goals of medicine. These goals are applied both to individual patients, and to the good of society as a whole. For example, the good health of a particular patient is an appropriate goal of medicine, and the prevention of disease through research and the employment of vaccines is the same goal expanded to the population at large.  It is sometimes held that nonmaleficence is a constant duty, that is, one ought never to harm another individual. Whereas, beneficence is a limited duty. A physician has a duty to seek the benefit of any or all of her patients, however, the physician may also choose whom to admit into his or her practice, and does not have a strict duty to benefit patients not acknowledged in the panel. This duty becomes complex if two patients appeal for treatment at the same moment. Some criteria of urgency of need might be used, or some principle of first come first served, to decide who should be helped at the moment.

4. The Principle of Justice   Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "giving to each that which is his due." This implies the fair distribution of goods in society and requires that we look at the role of entitlement. The question of distributive justice also seems to hinge on the fact that some goods and services are in short supply, there is not enough to go around, thus some fair means of allocating scarce resources must be determined.  It is generally held that persons who are equals should qualify for equal treatment. This is borne out in the application of Medicare, which is available to all persons over the age of 65 years. This category of persons is equal with respect to this one factor, their age, but the criteria chosen says nothing about need or other noteworthy factors about the persons in this category. In fact, our society uses a variety of factors as a criteria for distributive justice, including the following: to each person an equal share to each person according to need to each person according to effort to each person according to contribution to each person according to merit to each person according to free-market exchanges John Rawls and others claim that many of the inequalities we experience are a result of a "natural lottery" or a "social lottery" for which the affected individual is not to blame, therefore, society ought to help even the playing field by providing resources to help overcome the disadvantaged situation. One of the most controversial issues in modern health care is the question pertaining to "who has the right to health care?" Or, stated another way, perhaps as a society we want to be beneficent and fair and provide some decent minimum level of health care for all citizens, regardless of ability to pay.