UNIVERSAL ETHICAL
PRINCIPLES
AUTONOMY
- Recognizing patients as persons who are
entitled to such basic human rights such
as the right to know, privacy and right to
receive treatment
- ability of a person to make their own
decisions without interference
IMPORTANCE
Autonomy enhances a persons personal
worth
It protects a person from being used by
the others
It helps develop a mature therapeutic
alliance between health professionals and
patient
Violations
Actions performed that constrain a
persons capacity to make a decision
Actions performed that constrain a
persons capacity to act according to his
decision
Non-violations
A person expresses his autonomous wish
to waive consent or delegate authority to
others
Competence to give consent is absent or
reduced and the procedure considered is
necessary to save the persons life
Respecting a persons autonomy
competes with other moral principles as
autonomy vs. non-maleficence
PATERNALISM
Deliberate restriction of peoples
autonomy by health care professionals
based on the idea that they know whats
best for the clients- can be justifiable at
times
Doing good should take precedence over
autonomy
PRINCIPLE OF AUTONOMY
The right of the patient to accept or refuse the
physicians treatment. His option to choose is
based on respect of his free will.
Essential Elements:
A. The relationship of physician and patient is
governed by a moral contract.
B. The doctor promises to treat his patient according
to his best judgment.
C. The doctor, although he believes he
knows best, should fully inform his patient
and defer to the latters option to accept or
reject the proposed plans of management.
D. When the patient is incompetent, proxy
consent should be sought.
E. The patients right to decide is called
autonomy and should be respected unless
his actions constitute an evil act.
PRINCIPLE OF
INFORMED CONSENT
It is a patients right to exercise freedom to
make decisions for his/her health.
Appropriate and necessary information are
required so that medical protocols and
management may be done for his interest.
PRINCIPLE OF FREE AND
INFORMED CONSENT
To protect the basic need of every human
person for health care and the persons
primary responsibility for his or her own
health,
(1) no physical or psychological therapy maybe
administered without the free and informed
consent of the patient, or,
(2) if the patient is incompetent, the persons
legitimate guardian acting for the patients
benefit and, as far as possible, in accordance
with the patients known and reasonable wishes.
Elements of Informed Consent
1.Disclosure
2. Understanding
3. Voluntariness
4. Competence
5. Consent
Who are incompetent?
- Comatose
- Below 18 yrs old
- Mentally incoherent
PRINCIPLE OF
CONFIDENTIALITY
To whom should Medical information regarding
the patient be disclosed?
1. To the patient
2. Whoever is in charge
3. Those who maybe affected by the patients
health
4. To other legitimate authorities
How much should be told?
Information the average person needs in
order to make the decision
How may the illness affect the capacity of
the patient to perform the activities he is
responsible for/how the illness be
transmitted to them
When to break Confidentiality?
Patient is suicidal
If illness may endanger his performance
on a job or his own health as he performs
the job
Informing the public at risk of a community
with high prevalence of contagious
disease
CASE
A 30 year old married man consults a physician
complaining about his difficulty in urinating. He
attributes this to what he had taken five days ago when he
attended a convention. After examinations of his blood
and urine, he was told that he has Gonorrhea. He was
afraid the his wife might discover it. So he told the Doctor
not to tell anyone, including his wife for fear the she might
leave him. He loves his wife and family. The wife however,
after a week, asks the doctor as to the condition of her
husband because she was a bit worried why her husband
does not want to make love with her. If you are the doctor,
should you confide to the wife about her husbands
condition knowing that you know the obligation attached
to the Principle of Confidentiality?
Confidentiality
CASE
Jane is 14 years old and pregnant as a result of
incest with her father. On routine visit to the family
physician, Dr. XXX, she explains what has happened and
he confirms the pregnancy. She begs him not to tell her
parents, because then her mother will discover what has
happened. She is convinced that her mother will blame her,
rather than her father, because her relations with her
mother are very bad. Dr. XXX tells her he never performs
abortions so Jane asks him to refer her to some physician
who does. Dr. XXX wonders whether professional
confidentiality and perhaps even legal complications forbid
him from informing the mother and trying to stop the
abortion and the continuation of the incestuous relationship.
But he is also worried that Jane will go to a disreputable
and unsafe abortionist. What principles will help solve his
problem?
VERACITY
Duty to tell the truth
Fundamental to the development and
continuance of trust among human
beings- truth telling, integrity and honesty
PRINCIPLE OF
TRUTHFUL/PROFESSIONAL
COMMUNICATION
To fulfill their obligation to serve patients, health care
professionals have the responsibility to do the following
:
A. To strive to establish and preserve trust at both the
emotional and rational levels.
B. To share such information as they possess which is
legitimately needed by others in order to have an informed
conscience.
C. To refrain from lying or giving misinformation.
D. To keep secret information which is not legitimately needed
by others and that if revealed might harm the patient or
others or destroy trust.
SOME TIPS TO DELIVER
BAD NEWS WELL
1. Serious matters about ones health should be
discussed face to face in a quiet, comfortable, private
place, not in the hall, on the phone or in the middle of
the ground rounds with half a dozen strangers
listening.
2. Ideally, a caring relative or friend should be present to
provide emotional support and assist in gathering
critical information.
3. When imparting bad news the physician should allow
an open-minded amount of time free of interruption,
sit close to the patient at eye level, look directly to the
patient and, if appropriate, touch the patient.
SOME TIPS TO DELIVER BAD
NEWS WELL
4. Patients should be given as much
information as needed to understand the
condition, its treatment and the likelihood
that treatment will cure the illness or
control its symptoms.
5. Treatment options and the reasons for
more tests should be clearly described
along with their likely or possible side
effects so that people (patients) can make
intelligent choice.
FIDELITY
Obligation of an individual to be faithful to
commitments to him/herself and also to
others
Main support for the concept of
accountability
Keeping information confidential and
maintaining privacy and trust
BENEFICENCE
Duty to actively do good for patients
Primary goal of healthcare is to do good
for patients under their care
Non-Maleficence
one ought not to inflict evil or harm
It is related to the following human rights:
- Right not to be killed
- Right not to have bodily injury
- Right not to have ones confidence
revealed to others
Violations
Physically harming a person
Exposing a person to physical harm
Harming a persons reputation, honor,
property, interests as revealing confidential
information
Withholding information
Causing unnecessary expense for the
patient
Failure to use proper communication skills
Failing to provide spiritual counsel
Non-violations
The action in itself is good or indifferent
The good effect and not the evil effect is
not the one directly intended
The good effect is not produced by means
of the evil effect
There is proportionate reason for
permitting the foreseen evil effect to occur
PRINCIPLE OF BENEFICENCE
AND NON-MALEFICENCE
(Patient Benefit and Avoidance of Harm)
Prologue of Hippocratic Oath
I will use treatment to help the sick according to my
ability and judgment, but will never use it to injure or
wrong them.
JUSTICE
The duty to treat all patients fairly
Equal treatment of equal cases and equal
distribution of benefits- no discrimination
on the basis of sex, race, religion, age and
socioeconomic status
Involves allocation of scarce and
expensive health care resources
PRINCIPLE OF JUSTICE
Justice is a virtue which inclines man to
give others what is due them.
The duty to Treat All Patients Fairly,
Without Regard to Age, Socioeconomic
Status and Other Variables
- involves allocation of scarce resources
and expensive health care resources
-Either he gets what he deserves by right,
independent of the claim of others (noncomparative justice)
-Balancing of competing claims of other
persons against an individuals claim
according to some morally relevant
property or merit (comparative justice)
Implications of Justice
Each individual should receive what his
due by right
Benefits should be justly distributed
among individuals
Each individual should share in the burden
of health and science such as caring for
ones own health and health of others and
participating in health/science progress
Principle of Justice
Violations:
Denying/Withholding
a benefit to which a
person has a right
Distributing a
minimum health
benefit unequally
Imposing an unfair
burden on an
individual
Non-violations:
Person chooses to give
up what is due them
Loses their right to
what is due
Chooses to accept an
additional burden
When what appears to
be an unjust outcome
results from a just
process
Distributive Justice
A fair scheme of distributing societys
benefits and burdens to its members
Distributive Justice
Benefits- medical
care and treatment
Burdens- paying for
care and partaking in
experimental
research
Problems:
1. Macroallocation
2. Mesoallocation
3. Microallocation
TRIAGE
-Medical screening of patients to determine their
priority of treatment
2 principles:
1.
2.
-
Formal
Substantiative
Utilitarian
Egalitarian
Utilitarian Alternatives
Represents maximizing strategies to achieve the
greatest amount of good
- medical success
- immediate usefulness
- conservation
- parental role
- social value
Egalitarian alternatives
Represents maintaining or restoring the
equality of the persons in need
- saving no one
- medical neediness
- general neediness
- first come, first served (queuing)
- random selection
Distribution of Burdens
Justice demands that giving undue burden to
an individual requires his informed consent,
he must understand what is involved in the
burden and voluntary accept it
When a person chooses, as an act of charity,
to pay for another, donate an organ, subject
himself to an examination or experimental
procedure, JUSTICE is no longer an issue
CASE
One day before her delivery, Korina
came to the hospital. Her OB-Gyn advised her
that her baby will need an incubator right after
delivery. Her doctor, aware of the lack of such
equipment, told her to reserve for 3 days the only
incubator left. She paid in full the amount to the
hospital. In the meantime, another mother delivers
her baby and needs badly an incubator for her.
1. Should Korina give the incubator to the other baby
even at the prospect of needing it anytime?
2. Should the hospital have the right to get the incubator?
3. In cases such as this, what will you do?
PRINCIPLE OF
SUBSIDIARITY
Subsidiarity stems from the demands of the virtue of Justice. It recognizes
that no individual is self-sufficient. When he is unable to help himself, a
stronger or higher entity in the society is called to assist him. This is well
reflected in the Christian commitment to concretize Christs exhortation.
Whatever you do to the least of my brothers, you do it to me.
PRINCIPLE OF SUBSIDIARITY
Human communities exist only to promote and
share the common good among all their
members from each according to ability, to
each according to need in such a way that:
1. Decision making rests vertically first with the
person then with the lower social levels and
horizontally with the functional social levels
2. The higher social needs intervene only to
supply the lower units what they cannot achieve
by themselves while at the same time working
to make it easier for lower units and individuals
to satisfy these needs by their own efforts.
