4 (Four) clusters of principles:

1. Respect for autonomy respecting the decision making

capacities

2. Nonmaleficence avoiding the causation of harm 3. Beneficence providing & balancing benefits
against risks & costs

4. Justice distributing benefits, risks, & costs

fairly

1. Autonomy
self-rule (Greek) right of individuals to make choices See that people are different Personal choices Respecting people as equal persons with their own set of values a duty to let people make their own choices corresponding responsibilities of individuals towards society

Autonomous action
We analyze autonomous action in terms of persons who act
Intentionally With understanding Without controlling influences that determine their action

To respect an autonomous agent

is to acknowledge that persons right to hold views, to make choices, and to take actions based on personal values and beliefs. Such respect involves respectful action, NOT merely a respectful attitude. Respect involves treating persons to enable them to act autonomously, whereas disrespect for autonomy involves attitudes and actions that ignore, insult, or demean others autonomy and thus deny a minimal equity to persons.

Simple meanings

Self governance Liberty right Privacy Individual choice Freedom of the will

If you visit a doctor do you make treatment decisions on your own or in discussion with other family member, and the doctor

What factors could we use to make such decisions in our daily lives ?
When we make decisions for ourselves do we also have responsibility for what happens ?

2. Beneficence
Beneficence attempt to do good Balance doing good >< risk of doing harm Tools: - risk assessment

- cost-benefit analysis
Cases where beneficence >< autonomy?

Moralitas TIDAK HANYA kita menjamin autonomy dan menahan diri dari menimbulkan bahaya/ kerugian (harm), tapi juga harus memberi kontribusi bagi kesejahteraannya (welfare).
Pikirkan/ diskusikan tentang sebuah kasus dimana kita memerlukan keseimbangan antara benefit (kebaikan/ keuntungan) dari suatu tindakan yang membatasi autonomy seseorang untuk menentukan pilihan bebasnya. Pikirkan/ diskusikan tentang kemungkinan penggunaan sebuah teknologi kedokteran baru, dan identifikasikan benefits dan risks-nya.

3. Nonmaleficence
Precise outcome not always certain! Uncertainty risk of failure? chance of success? Try to minimize or avoid doing harm Failure to attempt to do good Form of doing harm Examples of risky technology?

Nonmaleficence vs beneficence
The principle of nonmaleficence asserts an obligation not to inflict harm intentionally. Principles of beneficence potentially demand more than the

principle of nonmaleficence, because agents must

take positive steps to help others, not merely refrain from harmful acts.

Prinsip nonmaleficence: wajib mencegah harm secara sengaja.

( Primum non nocere : above all (or at first) DO NO HARM) Nonmaleficence
One ought NOT to inflict evil or harm

Beneficence
One ought to prevent evil or harm
One ought to remove evil or harm One ought to do or promote good

Nonmaleficence
1. Do not kill 2. Do not cause pain

3. Do not incapacitate others

4. Do not cause offense to others 5. Do not deprive others of the goods of life

Dapatkah Anda pikirkan tentang sebuah teknologi yang diduga terlalu berisiko untuk digunakan sekarang ? Bila dapat, pikirkan pula teknologi mutakhir yang telah kita gunakan untuk hal yang sama. Ingat lagi ke belakang apakah teknologi mutakhir ini juga menimbulkan harm ?

4. Justice
Autonomy is limited by balancing desires with respect for the autonomy of other individuals Justice = fairness = equity equality in access to health care Problems: - Scarce resources/treatments for patients - Socioeconomic situation of patient & families - Healthcare system & healthcare budget

The concept of justice

The terms fairness, desert (what is deserved), and entitlement (that to which one is entitled) have been used by various philosophers in attempts to explicate justice. These accounts all interpret justice as fair, equitable, and appropriate treatment in light of what is due or owed to person.

Principles of distributive justice

To each person an equal share (formal equity)

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