Ethical Principles Part I

Four fundamental ethical principles

The Principle of Autonomy

is Latin for "self-rule" We have an obligation to respect the autonomy of other persons, which is to respect the decisions made by
other people concerning their own lives. This is also called the principle of human dignity. It gives us a negative duty not to interfere
with the decisions of competent adults, and a positive duty to empower others for whom we’re responsible.

Corollary principles: honesty in our dealings with others & obligation to keep promises.

The Principle of Beneficence

We have an obligation to bring about good in all our actions.

Corollary principle? We must take positive steps to prevent harm. However, adopting this corollary principle frequently places us in
direct conflict with respecting the autonomy of other persons.

The Principle of Non-maleficence

(It is not "non-malfeasance," which is a technical legal term, & it is not "non-malevolence," which means that one did not intend to
harm.)

We have an obligation not to harm others: "First, do no harm."

Corollary principle: Where harm cannot be avoided, we are obligated to minimize the harm we do.

Corollary principle: Don't increase the risk of harm to others.

Corollary principle: It is wrong to waste resources that could be used for good.

Combining beneficence and non-maleficence: Each action must produce more good than harm.

The Principle of justice

We have an obligation to provide others with whatever they are owed or deserve. In public life, we have an obligation to treat all
people equally, fairly, and impartially.
Corollary principle: Impose no unfair burdens.

Combining beneficence and justice: We are obligated to work for the benefit of those who are unfairly treated.

Ethical Principles Part II

Principle of Stewardship and other Ethical Principles

OTHER BASIC ETHICAL PRINCIPLES

1. Stewardship

This principle is grounded in the presupposition that God has absolute Dominion over creation, and that, insofar as human beings
are made in God’s image and likeness( Imago Dei), we have been given a limited dominion over creation and are responsible for its
care. The principle requires that the gifts of human life and its natural environment be used with profound respect for their intrinsic
ends. Accordingly, simply because something can be done does not necessarily mean that it should be done (the fallacy of the
technological imperative). As applied to Catholic-sponsored health care, the principle of stewardship includes but is not reducible to
concern for scarce resources; rather, it also implies a responsibility to see that the mission of Catholic health care is carried out as a
ministry with its particular commitment to human dignity and the common good.
 2. Epikeia

"The spirit of the law is greater than the letter of the law".

Epikeia is the principle in ethics that theorizes that a law can be broken in order to achieve a greater good.

St. Thomas Aquinas classified epikeia as a virtue, because it recognizes that in some occasions, it is permissible to set aside the law in
order to protect justice and the common good and either achieve a greater good or prevent a greater harm or evil, highlighting the
adage that laws are made for men, not men for laws.

3. Totality

These principles dictate that the well-being of the whole person must be taken into account in deciding about any therapeutic
intervention or use of technology. In this context "integrity" refers to each individual’s duty to "preserve a view of the whole human
person in which the values of the intellect, will, conscience, and fraternity are pre-eminent”.

” Totality" refers to the duty to preserve intact the physical component of the integrated bodily and spiritual nature of human life,
whereby every part of the human body "exists for the sake of the whole as the imperfect for the sake of the perfect".

4. Double Effect

An action that is good in itself that has two effects--an intended and otherwise not reasonably attainable good effect, and an
unintended yet foreseen evil effect--is licit, provided there is a due proportion between the intended good and the permitted evil.
When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether the
obligation to avoid evil requires one to abstain from a good action in order to prevent a foreseen but merely permitted concomitant
evil effect. The answer is that one need not always abstain from a good action that has foreseen bad effects, depending on certain
moral criteria identified in the principle of double effect. Though five are listed here, some authors emphasize only four basic moral
criteria (the fifth listed here further specifies the third criterion):

1.The object of the act must not be intrinsically contradictory to one's fundamental commitment to God and neighbor (including
oneself), that is, it must be a good action judged by its moral object (in other words, the action must not be intrinsically evil);

2.The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects as far as
possible, that is, one must only indirectly intend the harm;
3.The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other means of
achieving those effects are available;

4.The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate judgment);

5.The beneficial effects must follow from the action at least as immediately as do the harmful effects.

5. Cooperation

Along with the principles of double effect and toleration, the principles of cooperation were developed in the Catholic moral
tradition as a way of helping individuals discern how to properly avoid, limit, or distance themselves from evil(especially intrinsic
evil) in order to avoid a worse evil or to achieve an important good. In more recent years, the principles of cooperation have been
applied to organizations or "corporate persons" (the implication being that organizations, like individual persons, are moral agents).
Like the principle of double effect and some other moral principles, the principles of cooperation are actually a constellation of
moral criteria:

1. Formal Cooperation.

Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares in the
agent’s intention, either for its own sake or as a means to some other goal.

Implicit formal cooperation occurs when, even though the cooperator denies intending the object of the principal agent, the
cooperating person or organization participates in the action directly and in such a way that it could not be done without this
participation. Formal cooperation in intrinsically evil actions, either explicitly or implicitly, is morally illicit.

2. Immediate Material Cooperation.

Immediate material cooperation occurs when the cooperator participates in circumstances that are essential to the commission of
an act, such that the act could not occur without this participation. Immediate material cooperation in intrinsically evil actions is
morally illicit. There has been in the tradition a debate about the permissibility of immediate cooperation in immoral acts under
"duress." When individuals are forced under duress (e.g., at gunpoint) to cooperate in the intrinsically evil action of another, they act
with diminished freedom. Following Church teaching, the matter of their action remains objectively evil, but they do not intend this
object with true freedom. In such cases, the matter remains objectively evil as such, but the subjective culpability of the cooperator
is diminished. Very recently, the Vatican has rejected the arguments of those who would apply this concept of duress to Catholic
organizations as a way to justify their immediate material involvement in certain objectionable actions.
 3. Mediate Material Cooperation.

Mediate material cooperation occurs when the cooperator participates in circumstances that are not essential to the commission of
an action, such that the action could occur even without this cooperation. Mediate material cooperation in an immoral act might be
justifiable under three basic conditions: a. If there is a proportionately serious reason for the cooperation (i.e., for the sake of
protecting an important good or for avoiding a worse harm); the graver the evil the more serious a reason required for the
cooperation; b. The importance of the reason for cooperation must be proportionate to the causal proximity of the cooperator’s
action to the action of the principal agent (the distinction between proximate and remote); c. The danger of scandal (i.e., leading
others into doing evil, leading others into error, or spreading confusion) must be avoided.

6. Solidarity

The principle of solidarity invites us to consider how we relate to each other in community. It assumes that we recognize that we are
a part of at least one family - our biological family, our local community, or our national community - but then challenges us to
consider the full range of relationships with others. In a globalizing economy, we participate in a vast, international economic
community, one in which goods and services are provided for us by those on the other side of the world. Solidarity requires us to
consider this kind of extended community, and to act in such a way that reflects concern for the well-being of others.1.Participation
extends the idea of solidarity to make it practical. The demands of solidarity point us to the principle of participation, so that those
affected by an environmental decision can shape how it is made. Many, many environmental problems stem from decisions being
made by private individuals or companies that have wide-ranging implications. In some cases, in this country and others,
governments make environmental decisions without fully securing the consent of the public. Often, those most affected are
unaware of the decisions or the long-term effects on their health and the well-being of their environment. The ethical principle of
participation requires us to recognize all of the parties - human and non-human - likely to be affected by a decision, and to recognize
that all parties should have a say in how the decision is made. Genuine participation requires transparency, meaning that each
individual has access to the same information that everyone else has.

7. Respect for human rights

The human rights era started with the formation of the United Nations in 1945, which was charged with the promotion of human
rights. The Universal Declaration of Human Rights (1948) was the first major document to define human rights. Medical doctors have
an ethical duty to protect the human rights and human dignity of the patient so the advent of a document that defines human rights
has had its effect on medical ethics. Most codes of medical ethics now require respect for the human rights of the patient.

The Council of Europe promotes the rule of law and observance of human rights in Europe. The Council of Europe adopted the
European Convention on Human Rights and Biomedicine (1997) to create a uniform code of medical ethics for its 47 member-states.
The Convention applies international human rights law to medical ethics. It provides special protection of physical integrity for those
who are unable to consent, which includes children.

No organ or tissue removal may be carried out on a person who does not have the capacity to consent under Article 5.

As of December 2013, the Convention had been ratified or acceded to by twenty-nine member-states of the Council of Europe.
The United Nations Educational, Scientific and Cultural Organization (UNESCO) also promotes the protection of human rights and
human dignity. According to UNESCO, "Declarations are another means of defining norms, which are not subject to ratification. Like
recommendations, they set forth universal principles to which the community of States wished to attribute the greatest possible
authority and to afford the broadest possible support." UNESCO adopted the Universal Declaration on Human Rights and
Biomedicine to advance the application of international human rights law in medical ethics. The Declaration provides special
protection of human rights for incompetent persons.

In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken
into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals
respected.

8. Informed consent
Informed consent is a process for getting permission before conducting a healthcare intervention on a person. A health care provider
may ask a patient to consent to receive therapy before providing it, or a clinical researcher may ask a research participant before
enrolling that person into a clinical trial. Informed consent is collected according to guidelines from the fields of medical ethics and
research ethics.

An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications,
and consequences of an action. Adequate informed consent is rooted in respecting a person’s dignity. To give informed consent, the
individual concerned must have adequate reasoning faculties and be in possession of all relevant facts. Impairments to reasoning
and judgment that may prevent informed consent include basic intellectual or emotional immaturity, high levels of stress such as
PTSD or a severe intellectual disability, severe mental illness, intoxication, severe sleep deprivation, Alzheimer's disease, or being in a
coma.

Some acts can take place because of a lack of informed consent. In cases where an individual is considered unable to give informed
consent, another person is generally authorized to give consent on his behalf, e.g., parents or legal guardians of a child (though in
this circumstance the child may be required to provide informed assent) and conservators for the mentally ill.

In cases where an individual is provided insufficient information to form a reasoned decision, serious ethical issues arise. Such cases
in a clinical trial in medical research are anticipated and prevented by an ethics committee or Institutional Review Board.

Informed Consent Form Templates can be found on the World Health Organization Website for practical use.

9. Confidentiality
Confidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-
physician privilege. Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.

Confidentiality is mandated in America by HIPAA laws, specifically the Privacy Rule, and various state laws, some more rigorous than
HIPAA. However, numerous exceptions to the rules have been carved out over the years. For example, many states require
physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles. Confidentiality is also
challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a
spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient's parents. Many states
in the U.S. have laws governing parental notification in underage abortion.

Traditionally, medical ethics has viewed the duty of confidentiality as a relatively non-negotiable tenet of medical practice. More
recently, critics like Jacob Appel have argued for a more nuanced approach to the duty that acknowledges the need for flexibility in
many cases.

Confidentiality is an important issue in primary care ethics, where physicians care for many patients from the same family and
community, and where third parties often request information from the considerable medical database typically gathered in primary
health care.

10. Two wrongs make a right

In rhetoric and ethics, "two wrongs make a right" and "two wrongs don't make a right" are phrases that denote philosophical norms.
"Two wrongs make a right" is a fallacy of relevance, in which an allegation of wrongdoing is countered with a similar allegation. Its
antithesis, "two wrongs don't make a right", is a proverb used to rebuke or renounce wrongful conduct as a response to another's
transgression.

Examples
This is an informal fallacy that occurs when assuming that, if one wrong is committed, then another wrong will cancel it out.

 Speaker A: You shouldn't embezzle from your employer. It's against the law.
 Speaker B: My employer cheats on their taxes. That's against the law, too!

The unstated premise is that breaking the law (or the wrong) is justified, as long as the other party also does so. It is often used as a
red herring, or an attempt to change or distract from the issue. For example:

 Speaker A: President Williams lied in his testimony to Congress. He should not do that.
 Speaker B: But you are ignoring the fact that President Roberts lied in his Congressional testimony!

Even if President Roberts lied in his Congressional testimony, this does not establish a precedent that makes it acceptable for
President Williams to do so as well. By invoking the fallacy, the contested issue of lying is ignored.

The tu quoque fallacy is a specific type of "two wrongs make a right". Accusing another of not practicing what they preach, while
appropriate in some situations, does not in itself invalidate an action or statement that is perceived as contradictory?
Criticism

Common use of the term, in the realm of business ethics, has been criticized by scholar Gregory S. Kavka writing in the Journal of
Business Ethics. Kavka refers back to philosophical concepts of retribution by Thomas Hobbes. He states that if something
supposedly held up as a moral standard or common social rule is violated enough in society, then an individual or group within
society can break that standard or rule as well since this keeps them from being unfairly disadvantaged. As well, in specific
circumstances violations of social rules can be defensible if done as direct responses to other violations. For example, Kavka states
that it is wrong to deprive someone of their property but it is right to take property back from a criminal who takes another's
property in the first place. He also states that one should be careful not to use this ambiguity as an excuse recklessly to violate
ethical rules.

Two wrongs don't make a right

Two wrongs don't make a right is a proverb that contradicts this fallacy – a wrongful action is not a morally appropriate way to
correct or cancel a previous wrongful action.