Chapter 4

Basic Principles of Health Care and

the Nature of Rights in Ethical
Discourse
Applied Ethics (slide 1 of 2)

• Basic Ethical Principles

– Determine right and wrong in regard to:
• Autonomy
• Veracity
• Confidentiality
• Beneficence
• Nonmaleficence
• Justice
• Role fidelity
Applied Ethics (slide 2 of 2)

• Hierarchy of thinking in regard to biomedical

ethics: proceed from general worldview, to
universal principles, to rules and codes, to
decisions
Universal Principles of Biomedical Ethics
(slide 1 of 11)
Universal Principles of Biomedical Ethics
(slide 2 of 11)
• Autonomy
– Form of personal liberty
• Ability to decide
• Power to act on your decisions
• Respect for the individual autonomy of others
– Self-determination often used synonymously
with autonomy
Universal Principles of Biomedical Ethics
(slide 3 of 11)
• Autonomy (continued)
– Informed consent
• Legal exceptions: under therapeutic privilege and
implied consent
– Paternalism: intentional limitation of autonomy
of one person by another
– Health care professionals fiduciary
relationship with patients
Universal Principles of Biomedical Ethics
(slide 4 of 11)
• Veracity
– Binds both health practitioner and patient in
an association of truth
– Harm to patient autonomy and potential loss
of practitioner credibility makes lying to
patients a practice to be avoided
Universal Principles of Biomedical Ethics
(slide 5 of 11)
• Beneficence
– Acts of mercy and charity
– Any action that benefits another
– Hippocratic Oath: physician will “apply
measures for the benefit of the sick”
Universal Principles of Biomedical Ethics
(slide 6 of 11)
• Nonmaleficence
– One ought not to inflict evil or harm
• Beneficence
– One ought to prevent evil or harm
– One ought to remove evil or harm
– One ought to do or promote good
Universal Principles of Biomedical Ethics
(slide 7 of 11)
• Nonmaleficence
– Principle of double effect: secondary effects
may be foreseen, but can never be intended
outcomes
– Under what circumstances can one act
morally when some of the foreseeable effects
of that action are harmful?
Universal Principles of Biomedical Ethics
(slide 8 of 11)
• Principles of Double Effect (Guiding Elements)
– Course chosen must be good or at least
morally neutral
– Good must not follow as a consequence of
secondary harmful effects
– Harm must never be intended but merely
tolerated as casually connected with good
intended
– Good must outweigh harm
Universal Principles of Biomedical Ethics
(slide 9 of 11 )
• Confidentiality
– American Hospital Association’s The Patient
Care Partnership: Understanding
Expectations, Rights and Responsibilities
• Outline of current state of practice with regard to
individual’s right to privacy in health care
Universal Principles of Biomedical Ethics
(slide 10 of 11)
• Justice
– Procedural justice or due process: disputes
between individuals
– Distributive justice: distribution of scarce
resources
– Compensatory justice: individuals seek
compensation for a wrong that has been done
Universal Principles of Biomedical Ethics
(slide 11 of 11)
• Role Fidelity
– Modern health care is the practice of a team
– Allied health over 100 individual professions
– Ethics of health care require practitioner
practice faithfully within constraints of role
– Prescribed by scope of practice of state
legislation
Rights (slide 1 of 2)

• Entitlements, interests, powers, claims, needs

• If one possesses a right, one need not feel
gratitude to others for its possession
• In moral philosophy and political theory thought
of as justified claims
• A right creates obligation in others to behave in
a certain way
Rights (slide 2 of 2)

• Symbolic language of covenants, charters,

manifestos, and conventions
– Expressions of hope for future of humanity
– Not meant to outline a reality grounded in law
or claims that can be enforced
Right to Health Care?

• Many claim health care as a human right. Is it?

• And if it is, where would such a right come from,
and who has obligation to provide it?
• Health care as a right difficult to define
• Is it is a positive or recipient right?
Historical Background of Rights Reasoning
(slide 1 of 3)

• Natural Rights
– Equated to the law of God such as Golden
Rule
• Natural Liberties
– Universal moral rights exist prior to and
independent of guarantees of social contract
or institutionalized government
– Negative rights: obligate others from
interference
Historical Background of Rights Reasoning
(slide 2 of 3)

• Human Rights
– All humans equally separated from beasts of
the field and are unique unto themselves
– Positive rights: basic needs we all share,
recognize, and respect as a person’s just due
– Basic truths understood and known by human
reason alone not dependent on outside
dictates
Historical Background of Rights Reasoning
(slide 3 of 3)

• Traditions of Natural Law

– Humans possess rational nature as a gift from
God
– Natural laws are not dependent on social contract
– Natural laws are unchangeable and universal
– Inability to effect natural rights does not
distinguish them
– Natural laws discovered even without knowledge
of God
Contractarian and Consequentialist Rights Theory (slide 1 of 4)

• John Stuart Mill

– Duties of perfect obligation: inherent within
them assigned correlative rights
– Duties of imperfect obligation: do not give
birth to any right
– Moral rights: backed up by force of law or
public opinion
Contractarian and Consequentialist Rights Theory (slide 2 of 4)

• Contractarian Theory
– Force or mechanism for selection of correct
principles is agreement or bargain reached by
initial agents
– Moral agents come to initial situation and
bargain to a choice
Contractarian and Consequentialist Rights Theory (slide 3 of 4)

• Hobbesian Model
– Those living in the state of nature do not
come to the table as equals
– Only law of self-preservation existed
– World where strong and ruthless armed with
force and fraud are only ones allowed to
come to bargaining table
Contractarian and Consequentialist Rights Theory (slide 4 of 4)

• John Rawls
– Original position: all individuals are free and
equal
– Veil of ignorance: denies each agents’
knowledge of who is to receive rights to goods
and services
– Seen in the fair opportunity rule
Fair Opportunity Rule

• Contractarians
– Individual rights grounded in principle of
justice and collective choice
– Collective choice forms basis of morality
• Original Position
– Posited concept of moral right to equal
concern and respect
– Rights existed prior to collective choice
procedure
Legal Rights (slide 1 of 2)

• Not only asserted as moral prerogatives but

afforded governmental guarantees
• Created through constitutional guarantees,
legislative statutes, judicial review, governmental
agencies
• Easier to put into place laws that protect
negative rights
Legal Rights (slide 2 of 2)

• Characteristics of a Legal Person

– Persons can be injured
– Persons can be thought to have interests
– Persons can be benefited
• Legal rights often used to reaffirm moral rights,
do not necessarily coincide
Moral and Legal Rights

• Universal
• Moral rights provide equality among humans
• Moral rights not product of human creativity, but
are inherent to our species
The Problem of Rights

• Multiplication of claims to personal rights

• Human imagination and creativity can create
more claims to rights than we could possibly
honor
Conclusion

• Ethics is philosophy with systematic approaches

to questions of morality
• We are guided by universal principles and moral
and legal rights
• As health care providers, more good is done by
honoring basic human rights that we have come
to know by experience and reason