BIOETHICS

BioEthics- Bioethics : a neologism derived from the Greek words bios (life) and ethike (ethics),
which the Oxford English Dictionary defines as the discussion and management of 'the ethical
issues relating to the practice of medicine and biology, or arising from advances in these
subjects'1.
Biomedical Ethics- Is the critical examination of decision making.
Biomedical ethics refers to the ethical principles and values that guide decision-making and
behavior in the field of healthcare and biomedical research. It involves examining the moral
implications of medical practices, policies, and advancements, and ensuring that they align with
ethical standards and principles. Biomedical ethics aims to address complex ethical dilemmas
that arise in healthcare, such as patient autonomy, justice, beneficence, and non-maleficence.

Principles of Biomedical Ethics:

 Autonomy: Autonomy refers to respecting the rights and decisions of individuals. In
healthcare, it means that patients have the right to make informed decisions about their
own medical treatment and care. Healthcare professionals should provide patients with all
relevant information and respect their choices2.

 Justice: Justice involves fairness and equality in the distribution of healthcare resources
and access to medical treatment. It emphasizes the need to treat all individuals fairly and
without discrimination, ensuring that healthcare resources are allocated based on need
and not on factors such as race, gender, or socioeconomic status.

 Beneficence: Beneficence refers to the duty to act in the best interest of the patient and
promote their well-being. Healthcare professionals should strive to maximize benefits
and minimize harm when making decisions about patient care. This principle emphasizes
the importance of providing effective and compassionate care.

 Non-maleficence: Non-maleficence means to do no harm. Healthcare professionals have

a responsibility to avoid causing harm to patients and to minimize the risks associated
with medical interventions. This principle requires careful consideration of the potential
risks and benefits of medical procedures and treatments.

 Principle of Autonomy: The principle of autonomy is a fundamental principle in

biomedical ethics that recognizes the rights of individuals to make decisions about their

1
Wilson D. Manchester (UK): Manchester University Press; 2014.
2
Medical Ethics 101
 own healthcare3. It emphasizes that competent adults have the ultimate authority to
determine what happens to their bodies and to participate in the decision-making process
regarding their treatment options. Healthcare professionals are required to seek the
informed consent or agreement of the patient before any investigation or treatment takes
place4.

 Principle of Cooperation: The principle of cooperation in biomedical ethics emphasizes

the importance of collaboration and teamwork among healthcare professionals, patients,
and other stakeholders involved in the provision of healthcare. It recognizes that effective
healthcare delivery requires the cooperation and coordination of various individuals and
entities, including physicians, nurses, technicians, administrators, and patients. This
principle highlights the need for open communication, mutual respect, and shared
decision-making to ensure the best possible outcomes for patients5.

There are two major distinctions within the principle of cooperation: formal cooperation and
material cooperation.

1. Formal cooperation occurs when an individual intends, desires, or approves of

the wrongdoer's conduct. It involves actively supporting or participating in the
morally objectionable action6.
Examples of formal cooperation include a nurse assisting in an illicit operation
because they want the operation to be performed or a judge ruling in favor of a
couple's divorce, actively approving the divorce.

2. Material cooperation, on the other hand, occurs when an individual is involved

in the matter or the actual doing of the action but does not share the intention or
approval of the wrongdoer. It involves a more passive or indirect involvement in
the morally objectionable action7.
Material cooperation can be further categorized into immediate and mediate
cooperation based on the similarity or distinguishability of the object of the
cooperator's action compared to the wrongdoer's action.
 Immediate material cooperation occurs when the object of the cooperator's
action is the same as the object of the wrongdoer's action. It is generally
considered morally wrong, except in cases of duress.
 Mediate material cooperation occurs when the object of the cooperator's action
remains distinguishable from that of the wrongdoer's action. It can be morally
licit, provided there is a proportionately grave reason, and the object of
cooperation is as distant as possible from the wrongdoer's act.
3
Medical Ethics: Autonomy - The Medic Portal
4
Autonomy or self-determination as a medical student - BMA
5
Principles of Bioethics | UW Department of Bioethics & Humanities
6
Ethics - Cooperation: A Principle That Reflects Reality
7
Formal and Material Cooperation
Principle of Totality: The principle of totality, also known as the principle of integrity, is a
concept in biomedical ethics that recognizes the importance of considering the whole person in
healthcare decision-making. It emphasizes the interconnectedness of physical, psychological, and
social aspects of an individual's well-being. This principle highlights the need to address the
holistic needs of patients and to consider the impact of healthcare interventions on their overall
quality of life.
Principle of Double Effects: The principle of double effect is a moral principle that is often
applied in situations where an action may have both a good effect and a harmful effect.
According to this principle, it may be morally permissible to perform an action that has a
harmful effect if certain conditions are met. These conditions include: the action itself is morally
good or neutral, the harmful effect is not intended but merely foreseen, the good effect outweighs
the harmful effect, and there are no alternative actions that would achieve the same good effect
with less harm.

Principle of Double Effects:

1. The act itself must be good or indifferent.
2. The good effect is immediate or simultaneous (with evil effect)
(Good effect is not the result of an evil effect)
3. The purpose of the agent is the good effect.
4. The bad effect cannot outweigh the good effect.

Informed consent is a crucial concept that ensures patients have the necessary information to
make voluntary and informed decisions about their medical care. It involves the process of
healthcare providers educating patients about the risks, benefits, and alternatives of a given
procedure or intervention 8.
The elements of full informed consent typically include:
 Nature of the decision/procedure: Patients should be informed about the specific
procedure or intervention being proposed.
 Reasonable alternatives: Patients should be made aware of any reasonable alternatives
to the proposed intervention.
 Risks, benefits, and uncertainties: Patients should be informed about the potential risks,
benefits, and uncertainties associated with each alternative.
 Assessment of patient understanding: Healthcare providers should assess the patient's
understanding of the information provided.
 Acceptance of the intervention: The patient's acceptance or refusal of the intervention
should be respected9.

8
Informed Consent - StatPearls - NCBI Bookshelf
9
Informed Consent | UW Department of Bioethics & Humanities
It is important for the patient's consent to be considered valid, which requires the patient to be
competent to make the decision and for the consent to be voluntary. The healthcare provider
should create an environment that encourages voluntariness and ensures the patient understands
that they are participating in the decision-making process 10.
The amount of information considered "adequate" for informed consent can vary, but there are
generally three approaches:
 Reasonable physician standard: This approach considers what a typical physician
would disclose about the intervention.
 Reasonable patient standard: This approach focuses on what information an average
patient would need to know in order to make an informed decision.
 Subjective standard: This approach considers the specific information and
understanding required by the individual patient to make an informed decision.

10
Informed Consent | UW Department of Bioethics & Humanities