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S3 L1: Bioethical Principles
BIOETHICS
 The "ethics of life"
 Investigates practices and developments in the life sciences
and/or biomedical fields.
 Deals with those concerning life, health and death that have
resulted from modern biological technology and the way they
have affected human value.
Medical Ethics
 the oldest phase of bioethical exploration
 a formulation of ethical norms for the conduct of health care
professionals in the treatment of the patients
Bioethics Vs. Medical Ethics
 Biomedical Ethics or Bioethics = Human life issues.
 Medical Ethics = Patient Care
Medical Ethics involves the application of ethical principles to
Patient Care while Biomedical Ethics, or the common term Bioethics is the
application of our ethical and moral principles to human life issues.
Serge Hung Tope
Why Study Bioethics?
 Physician - patient relationship that is consensual and fiduciary
in nature
CONSENSUAL = based on mutual consent of both parties
FIDUCIARY = based in mutual trust and confidence
 Physician is a healer of another’s body
 Physician doesn’t have a total right and/or obligation over the
patient
 Physician must be guided by principles
 Physician must be able to decide on certain actions or
procedures without prejudice to the patient
PRINCIPLE OF NON-MALEFICENCE
 Do no harm
 Hippocratic Oath: "First of all, do no harm."
 Requires of us that we not intentionally or directly create a
needless harm or injury to the patient, either through acts of
commission or omission;
 Affirms the need for medical competence
 Non maleficence is not necessarily violated if a proper balance
of benefits exists
Providing a proper standard of care that minimizes risk of harm
is supported by one’s moral convictions and laws of society
If the harm is not directly intended but is rather an unfortunate
side effect of attempts to improve a person's health – the reason of violating
the principle of non-maleficence may be justified by the principle of DOUBLE
EFFECT.
PRINCIPLE OF BENEFICENCE
 Do good
 Positive expression of non-maleficence
Pretrans Edition
 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
 Highlights that we have a positive obligation to advance the
healthcare interests and welfare of our patients (including our
society) and to assist them in their choices to live life to the
fullest.
For example, the good health of a particular patient is an
appropriate goal of medicine, and the prevention of disease through research
and the employment of vaccines is the same goal expanded to the population
at large.
PRINCIPLE OF LEAST HARM
 Similar to beneficence, but deals with situations in which neither
choice is beneficial
 In this case, a person should choose to do the least harm
possible and to do harm to the fewest people
Some Notes on Ethical Principles
 There is no perfect system
 Systems evolve and develop
 Paternalism
 Autonomy and the Holocaust
 Social Justice and medical insurance in the 80’s
PRINCIPLE OF AUTONOMY
 "auto" and "nomos" = self-government, self-determination
 Affirms that we ought to be the authors of our own fate, the
captain of our own ship
 Moral right of an individual to determine what is good for
himself
 Mandates a strong sense of responsibility for one’s own life
 Central element on patient’s right
Implications
 A person has a right to determine what will be done to him
 Human beings should be allowed to make decisions for
themselves
 Human beings should be accepted as responsible for their
own actions and destinies.
 Doesn’t mean absolute freedom, man still has to follow the
guidelines of moral law
 A duty not to constrain another’s autonomous choices and
actions.
Positive Assets
 Enhances a person’s worth and self image
 Protects a person from being used or abused
 It develops a mature therapeutic alliance between patient
and physician
 Implies the capacity to think, decide, take action
 Mental incompetence limits autonomy
PRINCIPLE OF JUSTICE
 Rendering what is due or merited
 Equal distribution of harm and benefits, of burdens and comforts,
of goods and services among those who need them
 Allocation of healthcare resources according to a just standard
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Justice in health care is defined as a form of fairness, or as
Aristotle once said, "Giving to each that which is his due." This implies the
fair distribution of goods in society and requires that we look at the role of
entitlement.
2 Basic Types
Comparative
 What an individual or group receives is determined by
balancing the competing claims of individuals or
groups.
 Distribution determined by the gravity of the condition
or need.
Distributive / Non Comparative
 Distribution determined by a certain principle, rule or
standard.
 If you override this principle:
You endanger doctor-patient relationship which is
based on trust
 You offend against the principle of autonomy
 Fosters trust and shows respect
 Helps patients to become informed participants in health care
decisions
 Affirms the human and moral quality of the patient
 The facts belong to the patient, entrusted to the physician
 Withholding information in life and death situations deprives the
patient of time for preparation
 It may be justified to withhold information when:
o There is compelling reason to think that disclosure
would create a real and predictable harmful effect on
the patient
o The patient states an informed consent not to be told
the truth
o What if the patient’s family asks you to withhold a
terminal/serious diagnosis and prognosis?

HIPPOCRATIC OATH 2 Types of approach:

 Awareness/Idea of a Supreme Being Person Oriented - the physician has a moral obligation to inform
 Honor, integrity, professionalism the patient about his condition
 Passing on the torch Problem-oriented - considers the nature of the patient’s problem,
illness or condition
 Beneficence/ Non-Maleficence
 Justice THE PRINCIPLE OF CONFIDENTIALITY
 Value of human life from the womb  Based on loyalty and trust
 Proper referral  Maintain the confidentiality of all personal, medical and treatment
 Veracity information
 Confidentiality  Information to be revealed only with consent and for the benefit of
the patient
THE PRINCIPLE OF JUSTICE AND SOCIAL RESPONSIBILITY  Except when ethically and legally required
 Actions are consistent, accountable and transparent  Disclosure should not be beyond what is required
 Does not to discriminate on age, sex, religion, race, position or  t’s family asks you to withhold a terminal/serious diagnosis and
rank
prognosis?
 For the greater good of Society
 Respect for the Law
Exceptions to Medical Confidentiality:
 Equity and Distribution of Burdens & Benefits
 Patient gives a written and valid consent
THE PRINCIPLE OF PATERNALISM  To other participating professionals
 the act of being fatherly to someone  Statutory requirements
 Personal - a person decides on the basis of one’s best knowledge  Ordered by Court
on what is good for another  Public interest
 State - refers to the control exerted by legislature, an agency or  Approved Research
other governmental body over particular practices and procedures
in medicine SANCTITY/INVIOLABILITY OF LIFE
 Life is inviolable because it came from God
Personal  Only God has complete control and dominion over life
 The person is sick and seeks medical expertise and  Man’s life is holy and has an eternal destiny
assistance, part of patient’s autonomy is transferred to the  Each individual, regardless of the state of health, is not to be used
physician upon consultation as means, and is to be treated with dignity because he is valuable
 The recipient has some incapacity which prevents decision
making DIGNITY OF THE HUMAN PERSON
 There is possibility of harm unless a paternal decision is  Created in the likeness and image of God
made, benefit of intervention outweighs that of non-  Endowed with intelligence to know and a free will to decide or
interference, best interest of the patient choose
 Called into existence in relation to God
State Paternalism  Each person is unique and irreplaceable
 To improve the quality of medical education
 To upgrade the standard of medical care CHRISTIAN ETHICAL PRINCIPLES
 To control health related conditions such as drug addiction,  Inviolability/ Preservation of Life
spread of AIDS, and other communicable diseases  Stewardship/ Accountability
 Totality
THE PRINCIPLE OF VERACITY  Double Effect
 Truth telling  Cooperation
 Obligation to full and honest disclosure  Subsidiarity

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 Solidarity
 Personalized Sexuality

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