Chapter 3: The Moral Climate of Health Care

Section 5. Five Major Moral Principles in Health Care

In Health Care settings and in the institution itself there are a number of basic principles of morality which evidence themselves. Even if one did not approach cases or situations holding the principles of any of the standard ethical traditions there would arise these basic considerations and concepts.

No matter what the ethical approach taken, with the exceptions of egoism and relativism, there is agreement that there are certain basic principles related to health care that are consistent with the notion of the GOOD. They are presented here. There is disagreement about how they might be ordered or what to do in the event there is a conflict between or amongst them.

Those matters aside for now, there will be many occasions to make reference to these principles in the analysis and discussion of cases in Biomedical Ethics.

Five Major Moral Principles in Health Care:

  • I. NON MALFEASANCE
  • II. BENEFICENCE
  • III. UTILITY
  • IV. DISTRIBUTIVE JUSTICE
  • V. AUTONOMY

I. Non- Malfeasance- Do NO Harm!! Cause no needless harm or injury according to reasonable standards of performance.

Observe DUE CARE . This does not mean that there must be no risk of injury but only that there be no more than acceptable risks.

II. Beneficence- Promote the welfare of others. This is inherent in the relationship of a health care provider (HCP) and the recipient of care.

E.g. the doctor-patient relationship. However, what exactly is the duty of the HCP?

This comes into particular focus as problematical when the health care providers are also researchers. There must exist standards so that the benefits to the subjects and others are real and with a real possibility to be realized.

III. Utility- Attempt to bring about the greatest amount of benefit to as many people involved as is possible and consistent with the observance of other basic moral principles. Greatest Benefit and Least harm

IV. Distributive Justice- All involved should have equal entitlements, equal access to benefits and burdens. Similar cases should be treated in a similar fashion. People should be treated alike regardless of need, contributions or effort.

The formal principle of Justice as Fairness (Rawls’ Theory) similar cases are to receive the same treatment. However, in what ways are the cases similar? In what relevant ways? Equal in need? Equal in contributions to society? to the Health Care institution? Equal in effort?

V. Autonomy- People are rational, self determining beings who are capable of making judgments and decisions and should be respected as such and permitted to do so and supported with truthful and accurate information and no coercion.

They should have their decision making and actions: a) free of duress of any type, (b) based upon options that are clearly explained and that are genuine possibilities and (c) given the information needed for decision making.

Some believe that there can be justifications for violations of the principle of autonomy.

There are four principles cited to justify restrictions on AUTONOMY:

1. HARM Principle- stop an individual whose autonomy is restricted or violated from causing harm to others

2. PATERNALISM Principle-  There are two forms:

  • Weak -to stop a person whose autonomy is restricted or violated from self harm
  • Strong -to benefit the person whose autonomy is restricted or violated

3. LEGAL MORALISM Principle- legislated morality

Acts of legislation impose restrictions upon all, presumably for the benefit of all

4. WELFARE Principle- restrictions or violations of the autonomy of an individual for the benefit of all.

EXAMPLES:

Harm- if a person has a highly contagious and life threatening disease that person could be confined against that person's will

Paternalism-weak- a person attempting suicide by ingesting poison could have the stomach cleared of the poison in the ER even though refusing treatment.

Paternalism-strong- a 22 year old person could have a gangrenous leg amputated even against a refusal of treatment.

Legal Moralism - children can be inoculated against disease despite their refusal and that of their parents.

Welfare- a person with a rare anti-body to a deadly incurable disease threatening the general population could be made to give a specimen of their blood or bone marrow or other tissue for the sake of the benefit of the entire society.

More on What are the major principles of medical ethics?

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