MAJOR

BIOETHICAL
PRINCIPLE
 OBJECTIVES:

1. Define and describe the different basic

ethical principles.

2. Cite situation exemplifying the Major

bioethical principles.
Major :
Important, serious, significant
Bioethical :
The ethics, of medical and biological
research
Principles:
a fundamental truth or proposition that serves
as the foundation for a system of belief or
behavior or for a chain of reasoning
 MAJOR BIOETHICAL
PRINCIPLES:

1. Principle of respect for

autonomy
2. Principle of Beneficence
3. Principle of Non-
Maleficence
4. Principle of Justice
Principle of respect
for Autonomy
 Autonomy

is the freedom and ability to act in a self-

determined manner. It represents the
right of a rational person to express
personal decisions independent of outside
interference and to have these decisions
honored.
Respecting a patient’s autonomy includes:
obtaining informed consent for treatment
facilitating and supporting patients’ choices
regarding treatment options
allowing patients to refuse treatments
disclosing comprehensive and truthful
information, diagnoses, and treatment options to
patients
maintaining privacy and confidentiality.
Respecting the principle of
autonomy obliges the physician
to disclose medical information
and treatment options that are
necessary for the patient to
exercise self determination and
supports informed consent,
truthtelling, and confidentiality.
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. It
originates from the legal and ethical right the patient
has to direct what happens to her body and from the
ethical duty of the physician to involve the patient in
her health care.
FUNCTIONS OF THE PRINCIPLE OF
INFORMED CONSENT

Protects individual autonomy

Protects the patient's status as a human
being
Avoids fraud and duress
Encourages doctors to carefully consider
their decisions
fosters rational decision making by the
patient
Involves the public generally in medicine
Dempski (2009) presented three basic elements that are
necessary for informed consent to occur:

1. RECEIPT OF INFORMATION:

This includes receiving a description of the

procedure, information about the risks and
benefits of having or not having the treatment,
reasonable alternatives to the treatment,
probabilities about outcomes, and “the
credentials of the person who will perform the
treatment”.
2. CONSENT FOR THE TREATMENT MUST BE
VOLUNTARY:

A person should not be underany influence or be

coerced to provide consent. This means patients
should not be asked to sign a consent form when
they are under the influence of mind-altering
medications, such as narcotics. Depending on the
circumstances, consent may be verbalized, written,
or implied by behavior. Silence does not convey
consent when a reasonable person would normally
offer another sign of agreement.
3. PERSONS MUST BE COMPETENT:

Persons must be able to communicate consent

and to understand the information provided to
them. If a person’s condition warrants
transferring decision-making authority to a
surrogate, informed consent obligations must
be met with the surrogate.
Signing informed consent means

You have received all the information about

your treatment options from your health care
provider.
You understand the information and you have
had a chance to ask questions.
You use this information to decide if you want
to receive the recommended treatment
option(s) that have been explained to you.
If you agree to receive all or some of the
treatment options, you give your consent
(agree) by signing a consent form. The
completed and signed form is a legal
document that lets your doctor go ahead with
the treatment plan.
 Why do the
patient have to
sign a consent
form?
The main purpose of the informed consent process is to
protect the patient. A consent form is a legal document
that ensures an ongoing communication process
between you and your health care provider.
 What if the patient
doesn't want the
treatment being offered?
The patients has the right to refuse any and all
treatment options. He may also choose other
treatment options that have been presented to
him by his health care provider, even if they are
not as well proven as the one his health care
provider recommends. He may also refuse part
of the treatment options, without refusing all
care.
WHAT SHOULD OCCUR IF
THE PATIENT CANNOT
GIVE INFORMED
CONSENT?
If the patient is determined to be
incapacitated/incompetent to make health care
decisions, a surrogate decision maker must speak
for her.
 Scenario
A 64-year-old woman with MS is hospitalized. The team feels she may
need to be placed on a feeding tube soon to assure adequate
nourishment. They ask the patient about this in the morning and she
agrees. However, in the evening (before the tube has been placed), the
patient becomes disoriented and seems confused about her decision to
have the feeding tube placed. She tells the team she doesn't want it in.
They revisit the question in the morning, when the patient is again lucid.
Unable to recall her state of mind from the previous evening, the patient
again agrees to the procedure.
Is this patient competent to decide? Which preference should be honored?
Truth-Telling
(veracity)

is seen as a basic moral principle, rule,

or value. Withholding information or
otherwise deceiving the patient would
seem to at least disrespect patient
autonomy and potentially harm the
patient.
Truth-telling is a vital component
in a physician-patient relationship;
without this component, the
physician loses the trust of the
patient.
 Scenario
John, a 54 year old male patient, consented to surgery for probable
malignancy in his thyroid gland. After the surgery, the physician told
him that the diagnosis had been confirmed and that the tumor had
been successfully removed, but he did not inform him of the likelihood
of lung metastases and death within a few months. However, the
physician informed John's wife about the fuller diagnosis and about
the prognosis and it was agreed to conceal the diagnosis and
prognosis from John. The physician told John that only "preventive"
treatment was needed and John consented to radiation therapy and
chemotherapy. The physician did not inform John of the probable
causes of his subsequent shortness of breath and back pain. Unaware
of his impending death, John died 3 months later.
Confidentiality

is one of the core duties of medical

practice. It requires health care
providers to keep a patient’s personal
health information private unless consent
to release the information is provided by
the patient.
Patients routinely share personal information
with health care providers. If the confidentiality
of this information were not protected, trust in
the physician-patient relationship would be
diminished. Patients would be less likely to
share sensitive information, which could
negatively impact their care.
 Why is confidentiality important?
Creating a trusting environment by respecting patient
privacy encourages the patient to seek care and to be
as honest as possible during the course of a health care
visit.
It may also increase the patient’s willingness to seek
care. For conditions that might be stigmatizing, such as
reproductive, sexual, public health, and psychiatric
health concerns, confidentiality assures that private
information will not be disclosed to family or employers
without their consent.
 Scenario

Your 36-year-old patient has just tested

positive for HIV. He asks that you not inform
his wife of the results and claims he is not
ready to tell her yet.

What is your role legally? What would you say

to your patient?
Paternalism/ MEDICAL
PATERNALISM

It refers to courses of action (including

decisions) that are done in the assumed
interest of a person, but without or
against that person's informed consent.
types of paternalism
1. With regard to recipients welfare justifications

→Pure paternalism:
interventions for a
person’s life for the sole welfare of that
person (Ex: the child is told by his parentsto eat vegetables because it is good
for his health)

→impure Paternalism:
interference with another person not only for that person’s welfare but also for the
welfare of another
(Ex: A Jehovah’s Witness must have a
blood transfusion not only for his owngood but also for the good of his children)
 2. With regard to the recipient’s defect and safety

→Restricted Paternalism:
supports intervention which overrides an individual’s
action because of some defect or weakness in that
individual (Ex. One may prohibit a child from doing
something because of chronological or psychological
incompetence)

→Extended Paternalism:
is one on which an individual is restrained from doing
something because it is too risky or dangerous (Ex. Riding
motorcycles without wearing helmets is not encourage
because of the imminent danger it incurs)
 2. WITH REGARD TO THE PROMOTION
OF GOOD ANDPREVENTION OF HARM
→
o Positive:
Ex. When a patient is forced into a
rehabilitation program to promote
his/her own good

→Negative:
Ex. When cigarettes orweapons are taken
away to prevent an Individual from any
harm or violence
 01
SOFT PATERNALISM:
The use of paternalism to protect persons
from their own nonvoluntary conduct.
People justify its acceptance when a person
may be unable to make reasonable,
autonomous decisions. Examples of when
soft paternalism is used include situations
3. WITH REGARDS TO THE involving depression, substance abuse, and
PATIENT SENSE OF VALUES: addiction.

02
HARD PATERNALISM:
“Interventions intended to prevent or
mitigate harm to or to benefit a person,
despite the fact that the person’s risky
choices and actions are informed, voluntary,
and autonomous”
4. With regard to the recipient of the benefit

→Direct Paternalism:
the individual whoshould receive the supposed benefit is theone whose
values are overridden ordisregarded for his own good (Ex.
Themotorcyclist who is forced by law to wearhelmet is the one who
will benefit in caseof an accident.

→Indirect Paternalism:
a particularindividual will be benefited, if one personis restrained
from doing something (Ex.Child abuse, in which parents arerestrained by
law in some way to protectthe child)
5. LEGAL MORALISM

IMMORTALITY/ IMMORAL BEHAVIOR

EX: SUICIDE

6. SOCIAL WELFARE

TO BENEFIT OTHERS
PRINCIPLE OF
BENEFICENcE
 Principles of
beneficence :

The ordinary meaning of this

principle is the duty of health
care providers to be of a
benefit to the patient, as well
as to take positive steps to
prevent and to remove harm
from the patient.
 UNDER THE PRINCIPLES
OF BENEFICENCE,

1. One ought to prevent evil or harm.

2. One ought to remove evil or harm.

3. One ought to do or promote good

 The practitioner should act in " the
best interest" of the patient- the
procedure be provided with the
intent of doing good to the patient.

This needs health care provider to,

1. develop and maintain skills and
knwoledge by continually updating
the training.
2. consider individual circumstances of
all patient.
BEAUCHAMP AND CHILDRESS DISTUINGUISH BETWEEN SPECIFIC BENEFICENCE
AND GENERAL BENEFICENCE
SPECIFIC
BENEFICENCE
Is obligatory beneficence. It refers to
those positive obligations (i.e., duties to
act) we owe to others to further their
important and legitimate interests. We
owe a duty of specific beneficence to
those others with whom we are in some
special relationship.
GENERAL
BENEFICENCE
Is directed beyond those special
relationships to all persons. For the
most part,
is ideal beneficence—that is, although
moral ideals encourage us to act
affirmatively so as to help others with
whom we do not find ourselves in a
special relationship,
we are not obliged to do so by the
moral rules
 CASE #2

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.
PRINCPLE OF
NON-
MALEFICENCE
 Principles of
nonmaleficence :
the principle of "Non-
Maleficence" requires an
intention to avoid needles
harm or injury that can arise
through acts of commision or
omision.
In common language, it can be
considred "negligence" if you
impose a careless or unreasonable
risk of harm upon another.
 The legal criteria for
determining negligence are as
follows:
1. The professional must have a duty to
the affected party.
2. The professional must breach that
duty.
3. The affected party must experience
harm.
4. The harm must be caused by the
breach of duty.
This principle affirms that need for
medications competence. It is clear that
medical mistakes occur; however, this
principle articulates a fundamental
commitment on the part of heath
professionals to protect their patients
from harm.
 CASE #3:

32yr patient tests positive for autosomal

dominant heart condition that has 4%
annual risk of sudden death. His brother is a
pilot but patient specially does not want his
brother to know as he might lose his job.

Should the brother be informed?


YES
Duty of beneficence and non-
maleficence to brother
-effective preventative treatments
Likelihood and seriousness of harm
(cardiac death) justifies disclosure
Risk to others- duty to act in their
best interests
NO
Brother may not want to do-
doctor should respect his
autonomy (right not to know)
Impacts on employment of
brother
Should respect autonomy of
patient
Conflicts with Hippocratic
Oath ( duty of confidentiakity)
PRINCIPLE OF
JUSTICE
 Principle of Justice:

What is Justice?

as a principle in healthcare
ethics, refers to fairness,
treating people equally and
without prejudice, and the
equitable distribution of
benefits and burdens,
including assuring fairness in
biomedical research.
 Distributive Justice
and
social justice
Distributive justice refers to the fair
allocation of resources, whereas social justice
represents the position that benefits and
burdens should be distributed fairly among
members of a society, or ideally that all
people in a society should have the same
rights, benefits, and opportunities.
This implies the fair distribution of goods in
society and requires that we look at the role of
entitlement. In fact, our society uses a variety of
factors as criteria for distributive justice,
including the following:

to each person an equal share

to each person according to need
to each person according to effort
to each person according to merit
to each person according to free-market
exchanges
 CASE #4:
You have recently been speaking to your nursing
colleagues about Mr. Goodwin, a patient from the
community that comes to hospital once per week to
receive a nurse-administered medication. You have been
wondering whether it is appropriate to keep treating Mr.
Goodwin in hospital, given that he would be eligible for
community care support to have his medication
administered in the home. The reason that he has
continued to come to hospital to receive this medication is
that it is not covered by any Ministry of Health program,
and the hospital absorbs the cost for Mr. Goodwin at each
treatment. You are not sure whether this is an appropriate
use of resources since there are significant wait times for
other procedures, and cost savings initiatives are being
pursued in all other departments.
 In summary :
*Respect for person : is the patients *right
to decide for the treatment
*Beneficence: do what is best for the
patient
*Nonmaleficence : is to do no harm
*Justice : equal access to treatment
THANK YOU!