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BIOETHICS
GROUP IV
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Miranda, Maria Erica Jan S.
Caluag, Dain Aliana R.
Ide, Saki
Crisostomo, Charlene Justeen
Concubierta, Jordan
Yabut, Russel

What are the major principles of medical ethics?

Four commonly accepted principles of health care ethics, excerpted from
Beauchamp and Childress (2008), include the:
1. Principle of respect for autonomy,
2. Principle of nonmaleficence,
3. Principle of beneficence, and
4. 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, imply 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.
Case 1
In a prima facie sense, we ought always to respect the autonomy of the patient.
Such respect is not simply a matter of attitude, but a way of acting so as to
recognize and even promote the autonomous actions of the patient. The
autonomous person may freely choose values, loyalties or systems of religious
belief that limit other freedoms of that person. For example, Jehovah's Witnesses
have a belief that it is wrong to accept a blood transfusion. Therefore, in a lifethreatening situation where a blood transfusion is required to save the life of the
patient, the patient must be so informed. The consequences of refusing a blood
transfusion must be made clear to the patient at risk of dying from blood loss.
Desiring to "benefit" the patient, the physician may strongly want to provide a
blood transfusion, believing it to be a clear "medical benefit." When properly and
compassionately informed, the particular patient is then free to choosewhether to
accept the blood transfusion in keeping with a strong desire to live, or whether to
refuse the blood transfusion in giving a greater priority to his or her religious
convictions about the wrongness of blood transfusions, even to the point of
accepting death as a predictable outcome. This communication process must be

compassionate and respectful of the patients unique values, even if they differ
from the standard goals of biomedicine.
Discussion
In analyzing the above case, the physician had a prima facie duty to respect the
autonomous choice of the patient, as well as a prima facie duty to avoid harm and
to provide a medical benefit. In this case, informed by community practice and the
provisions of the law for the free exercise of one's religion, the physician gave
greater priority to the respect for patient autonomy than to other duties. However,
some ethicists claim that in respecting the patients choice not to receive blood, the
principle of nonmaleficence also applies and must be interpreted in light of the
patients belief system about the nature of harms, in this case a spiritual harm. By
contrast, in an emergency, if the patient in question happens to be a ten year old
child, and the parents refuse permission for a life saving blood transfusion, in the
State of Washington and other states as well, there is legal precedence for
overriding the parent's wishes by appealing to the Juvenile Court Judge who is
authorized by the state to protect the lives of its citizens, particularly minors, until
they reach the age of majority and can make such choices independently. Thus, in
the case of the vulnerable minor child, the principle of avoiding the harm of death,
and the principle of providing a medical benefit that can restore the child to health
and life, would be given precedence over the autonomy of the child's parents as
surrogate decision makers (McCormick, 2008).
2. The Principle of Nonmaleficence
The principle of nonmaleficence requires of us that we not intentionally create a
harm or injury to the patient, either through acts of commission or omission. In
common language, we consider it negligent 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 (see Law and Medical
Ethics). This principle affirms the need for medical competence. It is clear that
medical mistakes may occur; however, this principle articulates a fundamental
commitment on the part of health care professionals to protect their patients from
harm.
Case 2
In the course of caring for patients, there are situations in which some type of harm
seems inevitable, and we are usually morally bound to choose the lesser of the two
evils, although the lesser of evils may be determined by the circumstances. For
example, most would be willing to experience some pain if the procedure in

question would prolong life. However, in other cases, such as the case of a patient
dying of painful intestinal carcinoma, the patient might choose to forego CPR in
the event of a cardiac or respiratory arrest, or the patient might choose to forego
life-sustaining technology such as dialysis or a respirator. The reason for such a
choice is based on the belief of the patient that prolonged living with a painful and
debilitating condition is worse than death, a greater harm. It is also important to
note in this case that this determination was made by the patient, who alone is the
authority on the interpretation of the "greater" or "lesser" harm for the self.
Discussion
There is another category of cases that is confusing since a single action may have
two effects, one that is considered a good effect, the other a bad effect. How does
our duty to the principle of nonmaleficence direct us in such cases? The formal
name for the principle governing this category of cases is usually called
the principle of double effect. A typical example might be the question as to how to
best treat a pregnant woman newly diagnosed with cancer of the uterus. The usual
treatment, removal of the uterus is considered a life saving treatment. However,
this procedure would result in the death of the fetus. What action is morally
allowable, or, what is our duty? It is argued in this case that the woman has the
right to self-defense, and the action of the hysterectomy is aimed at defending and
preserving her life. The foreseeable unintended consequence (though undesired) is
the death of the fetus. There are four conditions that usually apply to the principle
of double effect:
1. The nature of the act. The action itself must not be intrinsically wrong; it
must be a good or at least morally neutral act.
2. The agents intention. The agent intends only the good effect, not the bad
effect, even though it is foreseen.
3. The distinction between means and effects. The bad effect must not be the
means of the good effect,
4. Proportionality between the good effect and the bad effect. The good effect
must outweigh the evil that is permitted, in other words, the bad effect.
(Beauchamp & Childress, 1994, p. 207)
The reader may apply these four criteria to the case above, and find that the
principle of double effect applies and the four conditions are not violated by the
prescribed treatment plan.

3. The Principle of Beneficence

The ordinary meaning of this principle is that health care providers have a duty 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 rational and self-evident
and are widely accepted as the proper goals of medicine. This principle is at the
very heart of health care implying that a suffering supplicant (the patient) can enter
into a relationship with one whom society has licensed as competent to provide
medical care, trusting that the physicians chief objective is to help. The goal of
providing benefit can be 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, a 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.
Case 3
One clear example exists in health care where the principle of beneficence is given
priority over the principle of respect for patient autonomy. This example comes
from Emergency Medicine. When the patient is incapacitated by the grave nature
of accident or illness, we presume that the reasonable person would want to be
treated aggressively, and we rush to provide beneficent intervention by stemming
the bleeding, mending the broken or suturing the wounded.
Discussion
In this culture, when the physician acts from a benevolent spirit in providing
beneficent treatment that in the physician's opinion is in the best interests of the
patient, without consulting the patient, or by overriding the patient's wishes, it is
considered to be "paternalistic." The most clear cut case of justified paternalism is
seen in the treatment of suicidal patients who are a clear and present danger to
themselves. Here, the duty of beneficence requires that the physician intervene on
behalf of saving the patient's life or placing the patient in a protective environment,
in the belief that the patient is compromised and cannot act in his own best interest

at the moment. As always, the facts of the case are extremely important in order to
make a judgment that the autonomy of the patient is compromised.
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 criteria for distributive justice, including the following:
1. To each person an equal share
2. To each person according to need
3. To each person according to effort
4. To each person according to contribution
5. To each person according to merit
6. To each person according to free-market exchanges
(Beauchamp & Childress, 1994, p. 330)
John Rawls (1999) 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. Medicaid is also a program that is designed to
help fund health care for those at the poverty level. Yet, in times of recession,
thousands of families below the poverty level have been purged from the Medicaid

rolls as a cost saving maneuver. The principle of justice is a strong motivation

toward the reform of our health care system so that the needs of the entire
population are taken into account. The demands of the principle of justice must
apply at the bedside of individual patients but also systemically in the laws and
policies of society that govern the access of a population to health care. Much work
remains to be done in this arena.

APPLICATION OF BIOETHICAL PRINCIPLES TO THE CARE OF THE

SICK
INFORMED CONSENT
- is the process by which the treating health care provider discloses appropriate
information to a competent patient so that the patient may make a voluntary choice
to accept or refuse treatment.
FUNCTIONS:
1) Protects individual autonomy
2) Protects the patients status as a human being
3) Avoids fraud and duress
4) Encourages doctors to carefully consider their decisions
5) Fosters rational decision making by the patient.
6) Involves the public generally in medicine.

RIGHTS OF A PATIENT
1. RIGHT TO INFORMED CONSENT- Informed consent refers to the knowledge
or information about and the consent to particular form of medical treatment.
2. RIGHT TO INFORMED DECISION- Informed decision refers to the necessary
information of and decision on a medical treatment before and latter is carried out.

3. RIGHT TO INFORMED CHOICE- Informed choice refers to the necessary

information a patient should know about a medical treatment or experiment so that
a moral choice can be made.
4. RIGHT TO REFUSAL OF TREATMENT- The patient has the right to refuse
treatment to the extent permitted by law and to be informed of the medical
consequences of his action. Patients Bill of Rights Invasion of a persons body
without valid consent is an assault, and is subjected to legal sanctions.
Patients rights do not include the right to be allowed to die. A patient in a
moribund condition does not possess the necessary mental or emotional stability to
make an informed choice.