Health Care Ethics (Bioethics)

GROUP 2
(Consolidated Handout -
2A/2B/2C/2D)
TOPICS
A. Ethical

Principles 1. Autonomy

· Patient’s Bill of Rights

· Informed Consent
· Proxy Consent/ Legally Acceptable Representative
2. Confidentiality
3. Veracity
· Truth Telling and the Right of Information
4. Fidelity
5. Justice
6. Beneficence
7. Non- maleficence
B. Other Relevant Ethical Principles
1. Principle of Double Effect
2. Principle of Legitimate Cooperation
3. Principle of Common Good and Subsidiarity
 ETHICAL PRINCIPLES
Many people have found it much more helpful to appeal to a set of guiding
principles to help make determinations of what is and is not ethical in the world of
medicine rather than adopt full-fledged ethical theories about the way the world is
constituted, how we know that and what we are to do. The advantage of this is that we
can avoid arguments about theoretical assumptions and apply moral conceptions of the
good to real-life situations.
We can do this because there is widespread agreement on the primacy and
enduring value of four basic principles. However, these principles do not exist in
harmony. The demands of each principle may conflict in any given case, and there is no
generally accepted ranking system for appeal.
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ETHICAL PRINCIPLES

1. AUTONOMY 2. FIDELITY

3. NONMALEFICENCE 4. CONFIDENTIALITY

5. BENEFICENCE 6. VERACITY

7. JUSTICE 8. ACCOUNTABILITY

What are Ethical Principles?

Ethical principles are fundamental tenets that guide individuals and groups
toward morally responsible behavior. They articulate values like fairness, respect,
honesty, and beneficence, helping us navigate complex situations and make choices
that align with them.
1. Autonomy: Respecting individuals' right to make their own choices, free from
coercion.
2. Beneficence: Acting in the best interests of others and aiming to avoid harm.
3. Non-maleficence: The principle of "first, do no harm," minimizing potential
risks and harm to others.
4. Justice: Ensuring fairness and equitable treatment for all individuals.
5. Veracity: Committing to truthfulness and transparency in communication.
6. Confidentiality: Protecting individuals' privacy and the information entrusted
to them.
7. Fidelity: Keeping promises and upholding commitments made to others.
(https://www.asefoundation.org/e21researchgrant/https://
nursingassignmentsexpert.com/rough-draft-qualitative-res earch-critique-and-ethical-
considerations/ )
PRINCIPLE OF AUTONOMY
 The freedom to make decisions about oneself.
 The right to self-determination
 Healthcare providers must respect patients’ rights to make choices about
healthcare, even if the healthcare providers disagree with the patients' decisions.
 Self- governing
o Freedom to make choices about issues that affect one’s life.
 Respect for persons; unique and valuable members of the society
 Free to choose and implement one’s own decision, free from lies, restraint or
coercion.
 This principle assumes rational thinking on the part of the individual and may be
challenged when the rights of others are infringed upon by the individual.
* Lies, restraints, coercion = wrong decision
* No matter what, we must let patients decide for themselves.
* Autonomy is NOT absolute.

In medicine, respect for autonomy requires us to accept the free and informed
choices of competent patients or their designated decision-makers. In essence, this
means that we must abide by the choices made by patients, regardless of whether they
coincide with our values or assessments. Unlike nonmaleficence and beneficence, it is
not so obvious why respect for autonomy is a fundamental principle. There are several
opinions on this topic:
 Ultimately, the only thing that truly belongs to us is our beliefs and values. They
are highly personal and highly valued. Respecting the decisions of others based
on their beliefs and values is appropriate because it gives them their due as the
valuable concerns they have.

 Respecting the autonomy of others is a reciprocal arrangement. That is, we

respect the right of others to make decisions that reflect their values and beliefs
because we want others to respect the decisions, we make for ourselves.

 By respecting the autonomy of another, we acknowledge that he or she is the

most appropriate person to make decisions in his or her best interest. This may
have two rationales: First, the person making the decision is the one who will
have to live with the consequences, and second, an individual has the best
insight into what he or she values and what he or she considers good.
  In the domain of healthcare, respecting a patient’s autonomy includes: (Butts and
Rich, 2019)

1. Obtaining informed consents for treatment.

2. Facilitating and supporting patient’s choices regarding treatment
options
3. Allowing patients to refuse treatments.
4. Disclosing comprehensive and truthful information, diagnoses, and
treatment options to patients so that they can make informed
decision.
5. Maintaining privacy and confidentiality.

 Respecting patient’s autonomy is important, but it is also important for nurses to

receive respect for their professional autonomy (Butts and Rich, 2019)
Factors that affect decision:
 Emotions - Emotional well-being, mental health conditions, and psychological
factors such as anxiety, fear, or depression can influence how patients perceive
their health status and make decisions about treatment options. Emotional
responses to illness or medical interventions may vary widely among individuals
and can impact decision-making processes.

 Personal Beliefs and Values - Patients' personal beliefs, values, and

preferences regarding health, wellness, and medical interventions play a
significant role in decision-making. Some individuals may prioritize quality of life
over aggressive treatments, while others may prefer exhaustive medical
interventions. Religious or spiritual beliefs may also influence healthcare
decisions.

 Time - Time constraints can create pressure and urgency, influencing individuals
to make decisions quickly without thorough consideration of all available options
or potential consequences.

 Health Literacy - Patients with higher levels of health literacy are better
equipped to understand medical information, make informed decisions, and
engage in healthcare discussions with their providers. Conversely, those with
limited health literacy may struggle to comprehend complex medical concepts,
leading to uncertainty and potentially affecting their decision-making process.
Respecting patient autonomy but also considering limitations:
 While respecting autonomy is a core principle, there are limits. Clinicians can't
compromise their integrity or violate standards by fulfilling patient requests.
 Patients can't demand inappropriate treatment, refuse lifesaving care, or cause
harm to others.

 Justice and preventing harm can override autonomy. For example, notifying
sexual partners of a sexually transmitted disease protects their health.
Determining authentic choices:
 Choices must be free, informed, and made by a competent individual.
 Coercion can be subtle and influence decisions. Healthcare providers, family,
and society can all exert pressure. We must be aware of these influences and
ensure patients make authentic choices.
 Informed choices require access to all relevant information. Patients need to
understand the situation and treatment options to make decisions aligned with
their values.

Respecting autonomy beyond direct communication:

 When patients can't communicate, surrogates (designated decision-makers) or
advance directives help determine their wishes.
 Decisions made by surrogates or based on advance directives have the same
moral weight as those expressed directly by the patient.
PRINCIPLE OF AUTONOMY
Competent for Decision Making
- 18 y/o and above
Emancipated minor – self-supported, financially independent
 Female – 18
 Male – 24 and below – parental consent
Mentally coherent
 90 y/o – depends if mentally competent or not
 Illiterate – CAN give consent

 Thumb marks and initials are NOT used as a signatures

 For + initials – not allowed

 Signed by a closest relative,the patient gives the consent

PATIENT’S BILL OF RIGHTS
The establishment of patient rights standardizes the application of ethical
principles to particular medical situations. Such documents provide the framework by
which a patient can expect to receive care and by which members of a healthcare team
can best promote the rights for each patient. (National Library of Medicine, 2022)
1. Right to appropriate medical care and treatment
2. Right to informed consent
3. Right to privacy and confidentiality
 4. Right to disclosure of and access information
5. Right to choose healthcare provider and facility
6. Right to dignity
7. Right to religious beliefs and assistance
8. Right to access his own medical records
9. Right to leave against medical advice
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligations as a patient
14. Right to health education
15. Right to refuse diagnostic and medical treatment
/patients(https://samch.doh.gov.ph/index.php/patients-and-visitors-corner -rights)
PRINCIPLE OF FREE AND INFORMED CONSENT
It is a patient’s right to exercise freedom to make decisions for his/her health.
Appropriate and necessary information is required so that medical protocols and
management may be done for his interest.
CONSENT
 Refers to freely given agreement or permission
 Immediate family
 Patients have the right to informed consent before undergoing any medical
procedure. They must understand the risks, benefits, alternatives, and right to
refuse treatment.

· Adult – Patient, spouse if married, children of major age

· Below 18 – Parents, siblings, grandparents
ASSENT
 Approval of the person of anybody below 18 y/o
 Aged 7 - 17 y/o
Example: circumcision
To protect the basic need of every human person for health care and the person’s
primary responsibility for his or her own health
1. No physical or psychological therapy may be administered without the free
and informed consent of the patient, or
2. If the patient is incompetent, the person’s legitimate guardian acting for the
patient’s benefit and, as far as possible, in accordance with the patient’s
known and reasonable wishes.
Elements of Informed Consent
Disclosure
1. Procedure
2. Reason
3. Risks vs Benefits
 4. Prognosis
5. Cost
6. Alternatives
7. Understanding
8. Do not use medical jargons
9. Voluntariness
10. Patient if mentally competent
11. Competence
12. Consent
According to Beauchamp and Childress (2019), they divided the elements of an
informed consent into three categories.

1. Threshold elements (Pre-conditions)

a. Competence (ability to understand and decide)
b. Voluntariness (in deciding)
2. Information elements (In Deciding)
a. Disclosure (of material information)
b. Recommendation (of a plan)
c. Understanding (of a & b)
3. Consent elements.
a. Decision (in favor of a plan)
b. Authorization (of the chosen plan)
Beauchamp, T. L., & Childress, J.F. (2019). Principles of biomedical ethics (8th ed).
Oxford University Press, p.
122.
 The principle of informed consent is justified mainly by respect for autonomy.
Informed consent requires that patients receive all pertinent information about
their health condition and treatment options and explicitly choose their own
treatments. Whereas being informed is a prerequisite to exercising one’s
autonomy, the principle of informed consent stands on its own as an essential
consideration in the ethical practice of medicine. This principle ensures that the
patient’s will, not the provider’s, that is being carried out.

 Informed consent regarding a patient’s treatment is a legal and ethical issue of

autonomy (Butts & Rich, 2019).

The Legal Perspective on Informed Consent

● Though they may participate in obtaining the patient’s signature, nurses should
not obtain informed consent for a provider who will perform a patient’s invasive
procedure. However, nurses may be legally liable if they know or should have
known informed consent was not obtained and they do not appropriately notify
providers or supervisors about this deficiency (Butts & Rich, 2019).
 ● The nurse must help identify and facilitate patients’ opportunities to give informed
consent. Hence, one can say that it is a collaborative process among healthcare
professionals and patients.
Types of Consent
1. Express Consent- May take the form of either an oral or a written agreement.
- Usually, if the more invasive the procedure or the greater potential for risk
to the client, the greater need for written permission.
2. Implied Consent- Exist when the individual’s nonverbal behavior indicates
agreement.
- Often used for low to essentially non-risky procedures (Butts & Rich,
2019)
3. Proxy Consent - This is given by someone other than the patient to give
permission for a particular medical procedure.
Important Note/ Considerations:
When reasonable efforts have been made to obtain informed consent, but no one
is competent or available to provide the consent or time does not allow for informed
consent because of the threat or death and/or disability, it is permissible to proceed with
treatments and procedures without consent. (Butts & Rich, 2019).
Proxy Consent
Proxy consent in medical treatment refers to the authorization granted by
someone other than the patient to make medical decisions on their behalf. This typically
happens when the patient is unable to provide consent themselves due to:
 Minority: Children are considered too young to understand complex medical
decisions.
 Mental incapacity: Adults may lack the mental capacity to understand their
situation and make informed choices due to dementia, intellectual disability, etc.
 Unconsciousness: Patients may be unconscious due to accidents, illness, or
other reasons.
 Communication difficulties: Some individuals may have difficulty
communicating their wishes due to speech or language impairments.
Surrogate Decision Makers- Also known as proxy, is an individual who acts on behalf
of a patient and either is chosen by the patient, such as a family member; is court
appointed; or has authority to make decisions. (Butts & Rich, 2019)
Who gives proxy consent?
1. Durable Power of Attorney
 Designating somebody else to make a decision for me
 Authorization
2. Closest of kin
 Adult – married - spouse, children of major age
 Below 18 - parents, grandparents
 No spouse - siblings, uncles/aunts
(The-Ethical-Component-of-Nursing-Education-Integrating-Ethics-into-Clinical-
Experiences-.pdf)
PRINCIPLE OF CONFIDENTIALITY
Confidentiality confers an obligation on healthcare providers to protect the
personal information they collect on patients from being seen or used by people who do
not need to know the information. This means being vigilant about holding
conversations that include references to specific patients and keeping health care
information away from the ears of people who do not need to know, as well as keeping
patient records in secure and protected places. Anything stated to nurses or healthcare
providers by patients must remain confidential.

The only times this principle may be violated are:

 If patients may indicate harm to themselves or others
 If the patient permits for the information to be shared
 Requires the non-disclosure of private or secret information with which one is
entrusted
 ICN (2000) - “ the nurse holds in confidence personal information and uses
judgment in sharing this information”
 An important component of autonomy - maintains dignity and respect for the
person
 Do not the tell the diagnosis to those who are not directly involved – nurse aides
and janitors
§ If directly involved – needs to know dx
§ If not directly involved – use standard precaution ; No need to
mention the dx
The following are subjects of Confidentiality and should not be revealed to
anyone except for graver cause:
 Private Secrets
 Contractual Secrets - Secret comes first before the promise to keep the secret.
 Professional Secrets - Understanding at the very start that you will not say
anything before the secret comes out.

Graver Cause:
 Personal decision

 Reportable cause

 Legal case
Breaches of Confidentiality
 Computerization of Medical Records
 Access to hospital patient charts
 Patients discussed by colleagues

Mandatory Disclosure
 Communicable disease
 Child is physically abused
§ Report even if it is just a suspicion, report to SOCIAL SERVICES
§ Evidence of Child Abuse and Neglect
 Bruises in different stages of healing – “clumsy”
§ Black and blue – fresh
§ Yellowish – healing
 Bruises under the clothing
 Frequent hospitalization
 Child is guarded – withdraws from touch.
 Quiet when parents are around but talkative when only healthcare providers are
around.
 Failure to thrive.
 Child is sexually abused.
 Familiar with vulgar/ sex language
 Inspect perianal area.
 Abusers do not usually penetrate the vagina because it is easily detected by
police/ hospital.
 They usually penetrate the rectal area.
 Vulnerable adults
 Elderly
 Mental incapacity
VERACITY
Veracity, or truth-telling, is an ethical principle rooted in beneficence and essential in
providing patients with the information needed to pursue their own well-being. The
rationale is that patients can only act in their own interest if fully informed about their
medical condition, even when delivering difficult news.
 Duty to tell the truth.

 Fundamental to the development and continuance of trust among human beings’

truth telling, integrity and honesty

 This principle implies “truthfulness”

 Nurses need to be truthful to their clients.

 Veracity is an important component of building trusting relationships.

 The historical practice of withholding fatal prognoses to spare suffering has been
reconsidered, recognizing individuals' importance in making necessary
preparations, saying goodbyes, and finding closure.

 Veracity is not an absolute obligation; exceptions include cases involving minor

patients, where the level of detail may be adjusted based on age and maturity,
and situations where a patient explicitly opts not to be informed, transferring the
obligation to a decision-maker. Patients also have the right to control the amount
of information they receive, with the duty of veracity extending to providing
information at the level the patient desires, respecting autonomy. This principle
underscores the belief that patients have a right to information about their bodies,
facilitating informed decision-making in their best interest.
1.The Importance of Truth-Telling and Right Information
The importance of truth-telling is ingrained in individuals from childhood,
emphasizing that "honesty is the best policy." This ethical principle, often
demonstrated in various contexts, such as children's stories and legal
proceedings, is a foundation for the broader concept of trust within the healthcare
system.
2. Trust in the Healthcare System
For the healthcare system to function accurately and efficiently, trust is
paramount among all individuals and agencies involved. Trust is defined as the
unrestricted certainty that others will perform as expected, simplifying human life
by endowing expectations with assurance (Whitbeck, 1995).
3. Trust between Patients and Healthcare Providers
Patients rely on trusting healthcare providers to be competent and act in
their best interest. This includes trusting that healthcare professionals prioritize
patients' well-being, possess problem-solving skills, and demonstrate
compassion in decision-making.
4. Reciprocal Trust
Reciprocal trust is essential in healthcare relationships, with nurses also
relying on patients to provide accurate and complete information. Ethical issues
may arise when there is a perception of noncompliance or incomplete
information, potentially leading to harm.
5. Trust in Healthcare Relationships
Trust extends to interactions between healthcare agencies and their
employees. This involves trust in fulfilling responsibilities, providing necessary
resources, maintaining accreditation standards, and ensuring financial
compensation.
 6. Trust in Inanimate Objects
Beyond interpersonal relationships, trust extends to inanimate objects
crucial in healthcare. Healthcare professionals trust the reliability of medical
devices during critical moments, and patients trust the functionality of life-saving
equipment.
FIDELITY

§ The principle of fidelity is rooted in the obligation to be faithful in relationships

and matters of trust within the healthcare context. This ethical principle can be
interpreted narrowly as a commitment to keeping promises or more broadly
as actively upholding one's responsibilities in the patient-clinician relationship.
§ 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
§ Loyalty
§ The promise to fulfill all commitments
§ At its core, fidelity requires healthcare providers to keep implicit promises within
the patient-provider relationship. This involves acting in the patient's best
interest, maintaining confidentiality, obtaining informed consent, being honest,
providing education, and responsiveness to the patient's needs. A broader
interpretation expands these commitments to include additional trusts, such
as advocacy, a deeper level of respect, and other evolving commitments as
the relationship develops.
JUSTICE
Justice, as a fundamental principle in healthcare ethics, provides a broader
perspective beyond individual patient care. However, its application is challenging due
to various formulations and the contextual legitimacy of its considerations. This
complexity stems from the distinction between public and individual-level ethical
activities.
1. The duty to treat all patients fairly.
2. Equal treatment of equal cases and equal distribution of benefits - no
discrimination on the basis of sex, race, religion, age and socioeconomic
status
3. Involves allocation of scarce and expensive health care resources
4. Every individual must be treated equally.
5. This requires nurses to be nonjudgmental.
Triage
Medical screening of patients to determine their priority of treatment.
Colors
i. Red
 This color is typically assigned to patients with life-threatening
conditions or injuries that require immediate attention. Patients
coded red are the highest priority and need prompt medical
intervention to prevent further deterioration.

ii. Yellow
Patients with urgent but not immediately life-threatening conditions
are assigned the yellow color. These individuals may require
medical attention relatively quickly, but their conditions are not as
critical as those coded red.

iii. Green

Green is assigned to patients with non-urgent conditions. These

individuals may need medical care, but their conditions are not
immediately life-threatening, and they can typically wait longer for
treatment.

iv. Black

This color is often used for patients who are either deceased or
have injuries so severe that survival is unlikely, even with
immediate medical intervention. In some systems, black may be
used to indicate deceased patients.

Different Principles of Justice:

Public-level ethics often grapples with questions of fairness in distributing healthcare
resources. Common conceptions of distributive equity include:
§ To each person an equal share: Simple but neglects individual needs.
§ To each person according to need: Attractive but challenging in defining and
comparing needs.
§ To each person according to effort, contribution, or merit: Problematic due to
subjective judgment.
§ To each person according to free-market exchanges: The current system but
criticized for its oversimplification and disproportionate burden
PRINCIPLE OF BENEFICENCE AND NON-MALEFICENCE
* If stated in a positive manner, BENEFICENCE.
* If stated in a negative manner, NON-MALEFICENCE
BENEFICENCE
 This principle means “doing good” for others.
  The principle of seeking to do good for others in the field of nursing. It highlights
the diverse aspects of nursing, from direct patient care to research and public
health, all aimed at improving individuals' lives.
 Duty to actively do good for patients.
 Primary goal of healthcare is to do good for patients under their care.
-Nurses need to assist clients in meeting all their needs:
· Biological
· Psychological
· Social
3 Major Components:
 Do or Promote Good
Ensures we actively seek to improve well-being and not just avoid causing
harm. It drives positive actions that enhance lives.
 Prevent Harm
Emphasizes the importance of proactively avoiding any actions that could
cause physical or emotional suffering. It's a foundational step in doing
well.
 Remove Evil or Harm
Goes beyond mere prevention and encourages actively addressing
existing problems and alleviating suffering. It promotes a proactive
approach to improving situations.
NON-MALEFICENCE
 Nonmaleficence is the obligation in medical ethics to avoid causing harm to
others. It acknowledges the complexity of defining harm and highlights the
challenge of balancing the goal of not causing harm with the necessity of medical
interventions to restore health.

 Requires that no harm be caused to an individual, either unintentionally or

deliberately

 This principle requires nurses to protect individuals who are unable to protect
themselves

 Duty to prevent or Avoid Harm, Whether Intentional or Unintentional

 Does not mean avoidance of harm altogether... avoidance of harm unless the
action promises a greater good
 PRINCIPLE OF DOUBLE EFFECT
Derived from Catholic moral theory regarding the permissibility of acts that will
have both a harmful and a beneficial outcome.
To be justified, an act that has both a harmful and a beneficial outcome must
meet the following guidelines:
1. The act itself must be either good or morally neutral.
2. The good effects must be intended and the harmful ones unintended, though
they may be foreseen.
3. The harmful effects may not be a means to the beneficial or good effects.
Some sources add as a fourth criterion that the benefits of the act must outweigh the
harms. In the medical context it is usually taken as a given that any treatment option a
patient chooses is one in which the benefits outweigh the harms in the eyes of that
patient.
A medical example that meets the foregoing criteria is that of a pregnant woman in the
first trimester who is discovered to have ovarian cancer. Immediate and aggressive
radiation therapy may be necessary if there is to be any chance of recovery. Although
the radiation treatment may produce the morally good effect of saving the woman’s life,
it also entails killing the fetus. By the standards of double effect, this is a permissible act
because:
1. Radiation therapy is itself a morally neutral act.
2. The intention of the therapy is to eradicate the cancer, and though it is clear
that the therapy will also kill the fetus, it is not the intention to do so.
3. Killing the fetus is not what kills the cancer.
Principle of Legitimate Cooperation
To achieve a well-formed conscience, one should always judge it unethical to
cooperate formally with an immoral act (that is, directly to intend the evil act itself), but
one may sometimes judge it to be an ethical duty to cooperate materially with an
immoral act (that is, only indirectly intend its harmful consequences) when only in this
way can a greater harm be prevented, provided:

✓that the cooperation is not immediate and

✓ that the degree of cooperation and the danger of scandal are taken into account

TYPES OF COOPERATION

1. Formal Cooperation- refers to agreement in the will regarding the evil act. We
may never assist another person in an external sinful act and intend its
sinfulness. Such formal cooperation is always sinful, a sin against charity
(scandal), as well as of the same kind as the act in which one cooperates.

Example: Cecile wanted to abort her baby before leaving for abroad and her friend
agrees and advises her to take Mifeprex (common abortion pills). After aborting her
baby, she tells her mother about it and forgives her.
Example: To willingly drive someone to get an abortion, to pay for it, encourage it (if it
determines their will to do it), defend the doing of it etc. is gravely sinful, both against
charity and against life.

2. Material Cooperation
Assisting another person in an external sinful act by an action which is not
sinful, and without approving of the other's sinful act in one will be material
cooperation. Such cooperation may be immediate (necessary to the sinful
act) or mediate (secondary to the sinful act).

a. Immediate
- If one cooperates in an evil act by performing something that is essential for
the performance of the evil action.
- Any direct close cooperation in the sinful act of another, while claiming not to
embrace the evil intention, is tantamount to formal cooperation.

Example: Lending the money for an abortion out of a motive of friendship, is

inseparable from the allow abortion.

b. Mediate
- If one cooperates in an accidental or non-essential manner in the evil action
- Cooperation in the sinful act of another by an act that is secondary and
subservient to the sinful act, neither sharing in the deed or the evil intention
may be either proximate or remote from the evil act.

Example: Providing nursing care pre- or post-operatively for an abortion. It is

not an abortion, but it makes one possible.
The principle of legitimate cooperation, also known as the principle of double effect, is a
moral principle that states that it is permissible to participate in an action that has both
good and bad consequences, as long as the following conditions are met:

1. The action itself is good or morally neutral.

Examples:
Administering pain medication: Providing morphine to a terminally ill patient to
alleviate pain, even if it has the unintended side effect of hastening death.
Blood transfusion: Giving a blood transfusion to a Jehovah's Witness who
objects to transfusions based on religious beliefs, believing it is the
lesser of two evils compared to letting them die.
2. The good effect is intended and directly sought.
Examples:
 Treating an infection: Using antibiotics to treat a bacterial infection, even
though a side effect might be the destruction of some beneficial gut
bacteria.
Performing surgery: Carrying out a necessary surgery with a known risk of
complications, as the intended outcome is to improve the patient's
health.
3. The bad effect is not intended and is not directly sought.
Examples:
Pain medication example: While pain relief is intended, hastening death is not.
Surgery example: Complications are not desired, though inherent in the
procedure.
4. The good effect outweighs the bad effect.
Examples:
Pain medication example: The relief from pain significantly outweighs the
potential for hastened death in most cases.
Surgery example: The improvement in health outweighs the risks of
complications, assuming the benefits are deemed significant.
5. There are no other means available to achieve the good effect without also
causing the bad effect.
Examples:
Pain medication example: If there are no other effective ways to manage
the pain, then using morphine despite the side effect becomes more
justifiable.
Surgery example: If the surgery is the only viable option to address a life-
threatening condition, then the risks may be deemed acceptable.
The principle of legitimate cooperation is a complex and controversial issue, and there
is no consensus among ethicists about its precise formulation or application. However,
it is an important principle that is often invoked in discussions of medical ethics, such as
the ethics of end-of-life care, assisted suicide, and the use of new medical technologies.
·Barry, R. (2002). The Principle of Cooperation in Catholic Moral Theology. Oxford
University Press.
·Ten Have, H. (Ed.). (2011). Handbook of Global Bioethics. Springer.
·Macklin, R. R. (2014). Medical Ethics and the Law. Wiley-Blackwell.
· Cohen, I. G., Rothstein, M. A., & Annas, G. J. (Eds.). (2017). The Routledge Handbook
of Medical Law and Ethics. Routledge.

Principle of Common Good and Subsidiarity

The Relationship of Human Dignity and Solidarity to Common Good

Human Dignity- Defined as the intrinsic value of a person created in the image of God
and redeemed by Christ. Hence, no human being should have their dignity or freedom
compromised.
Solidarity- Refers to the virtue of active compassion enabling the human family to
share fully the treasure of material and spiritual goods.
Henceforth, Human dignity and Solidarity when combined leads to Common Good.
What is Common Good?
● It is the totality of social conditions allowing people to achieve their individual and
communal fulfillment.
● It is reached when we work together (solidarity) in order to improve the wellbeing
of people in our society and the wider world.
● The rights of the individual to personal possessions and community resources
must be balanced with the needs of the disadvantaged and dispossessed.
● “The principle of the common good, to which every aspect of social life must be
related if it is to attain its fullest meaning, stems from the dignity, unity and
equality of all people.”
Second Vatican Ecumenical Council, Gaudium et Spes, 26: AAS 58 (1966),
1046.
Catechism of the Catholic Church, 1905-1912.
● “A society that wishes and intends to remain at the service of the human being at
every level is a society that has the common good –– the good of all people and
of the whole person –– as its primary goal. The human person cannot find
fulfillment in himself, that is, apart from the fact that he exists ‘with’ others and
‘for’ others.”
Catechism of the Catholic Church, 1912.
John XXIII, Encyclical Letter Pacem in Terris: AAS 55 (1963), 272.
Responsibility of Everyone for the Common Good
● In order to attain the common good for everyone, all members of society are
involved.
● “Everyone also has the right to enjoy the conditions of social life that are brought
about by the quest for the common good.”
Pius XI, Encyclical Letter Quadragesimo Anno: AAS 23 (1931), 197.
Task of the Political Community
 “To ensure the common good, the government of each country has the specific
duty to harmonize the different sectoral interests with the requirements of
justice.”
Catechism of the Catholic Church, 1908.
 “The common good of society is not an end in itself; it has value only in reference
to attaining the ultimate ends of the person and the universal common good of
the whole of creation.”
John Paul II, Encyclical Letter Centesimus Annus, 41: AAS 83 (1991), 843-
845.
What is Subsidiarity?
“Let us keep in mind the principle of subsidiarity, which grants freedom to develop the
capabilities present at every level of society, while also demanding a greater sense of
responsibility for the common good from those who wield greater power. “
Laudato Si’ (“Praise Be”), Pope Francis, 2015, Chapter 5, #196.
● In line with the Catholic teaching, the principle of subsidiarity emphasizes the
role of individuals as a body of authority to look after the good for all. It involves
listening to everyone and giving everyone the opportunity to participate.
● It came from the latin word, “Subsidium”, which means to support or assist.
● Decisions in society need to be made at the lowest competent level. As a
prescriptive principle, Subsidiarity informs us how decision-making should be
delegated among social groups- in order to allow for authentic freedom and
human dignity.
● It affirms the right and responsibility in making decisions that may impact their
lives.
● Pope Francis (2020) has heightened that when the principle of subsidiarity is
implemented, it gives hope in a healthier and more just future together, aspiring
greater things, broadening our horizons.

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