Bioethics & Health Law:

Basic Moral Principles

Definition

1.
2. 3.

Bioethics 1) The study of ethical issues and decisionmaking associated with the use of living organisms Moral 1) concerned with the judgement of the goodness & badness of human actions & character the lesson or principle contained in or taught by a fable, story, or event rules or habits of conduct, with reference to standards of right & wrong

Objective

Show how ethical theory can illuminate problems in health care and help overcome limitations of past formulation of ethical responsibility

Unreasonable to expect any theory to overcome all limitations of time & place, & reach a universally acceptable perspective

Four clusters of principles

Respect for autonomy respecting the decisionmaking 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

Beneficence
Beneficence attempt to do good Balance doing good >< risk of doing harm Tools: - risk assessment - cost-benefit analysis

Cases where beneficence >< autonomy?

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?

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

Conflict / Dilemmas

Refusal for treatment Scarce resources New medical technology Socioeconomic situation Withholding & withdrawing treatment

Other specific issues: Responsibility to other health care providers Religion-social related issues Alternative medicine Research ethics

Conclusion
Bioethics is not about thinking that we can always find one correct solution to ethical problems. There can be different choices made after ethical reflection Fundamental ethical principles can aid decision making Bioethics is learning how to balance different benefits, risks and duties

References
1. 2.

3.
4.

5.

Macer, D.R.J. (editor). A Cross-Cultural Introduction to Bioethics. Bangkok: Eubios Ethics Institute, 2006. Beauchamp, T.L., Childress J.F. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994. Lo, B. Resolving Ethical Dilemmas. Baltimore: Williams & Wilkins, 1995. Jonsen A.R., Siegler, M., Winslade, W.J. Clinical Ethics, 5th ed. New York: McGraw-Hill, 2002. WHO Regional Office for South-East Asia. Health Ethics Teaching Guidelines for the SEAR Countries. New Delhi, 2002.