NUR3002

Ethical Principles in Health Care (1)

beneficence, non-maleficence,
autonomy, justice, informed consent

Dr Maria HUNG
16th Feb 2016
2 Learning Outcomes
After the lecture, students should be able to:
 Describe the principles based ethics for health care
including
 Autonomy and informed consent,
 Beneficence and paternalism,
 Nonmaleficence, and
 Justice.
 Apply ethical principles and ethical decision making
to the practice.

Dr. Maria HUNG

3 Ethics and Morals
 Ethics
“ethos” from Greek, means customs,
habitual usages, conduct, & character
 Moral
“mores” from Latin, means customs or
habit
 Interchangeably nowadays
refer to conduct, character and
motives involved in moral acts
Davis et al., 2010
Dr. Maria HUNG
4 Why Study Ethics?

 To make sound judgments, good

decisions, and right / better choices.

 Understand the goodness and badness

of motives and ends.

Pozgar, 2016
Dr. Maria HUNG
5 Principles of Ethics

Ethical principles are universal rules of

conduct, derived from ethical theories that
provide a practical basis for identifying
what kinds of actions, intentions, and
motives are valued.

Pozgar, 2016, p.14

Dr. Maria HUNG

6 Health Care Ethics
 Also called:
Medical ethics, nursing ethics, biomedical
ethics, bioethics, practical ethics
 Addresses 4 interrelated areas:
Clinical practice,
Allocation of scarce resources,
Human experimentation,
Health policy.

Dr. Maria HUNG Davis et al., 2010

7 Health Care Ethics & Law
 Legal rights
based in the law
 Ethical rights
based in moral philosophy such as ethical
principles and rules
 Positive rights
 one has a right to something,
 Negative rights
 one has a right to be left alone,

Dr. Maria HUNG

8 Health Care Ethics & Law

Ethical & Legal Ethical & Illegal

Health Care
Ethics & Law

Unethical & Unethical &

Legal Illegal

Dr. Maria HUNG

Davis et al., 2006
9 Principle-based ethics for
health care

The principles of autonomy, beneficence,

nonmaleficence and justice are not the only
principles an individual might apply, nor do
these principles preclude the application or value
of other rules that are widely considered to be
beneficial in the healthcare setting

Davis et al., 2006, p.83

Dr. Maria HUNG
10
The Four Principles
Respect for autonomy:
 respecting the decision-making capacities of
autonomous persons;

Beneficence:
 balancing benefits of treatment against the risks and
costs;

Non maleficence:
 avoiding causing harm;

Justice:
 respect for justice takes several forms: e.g. distribution of
a fair share of benefits

(Slowther, Johnson, Goodall & Hope, 2004)

11 Principle-based ethics for
health care
 To respect the integrity of the individual by
allowing self-determination
 To try to provide benefit in the medical
encounter
 To avoid doing harm
 To treat individuals in a fair and just manner

Davis et al., 2006

Dr. Maria HUNG
12 The principle of respect for
autonomy
 Includes obligations to:
‘acknowledge a person’s right to hold
views, to make choices, and to take
actions based on personal values and
beliefs’
build up or maintain others’ capacities
for autonomous choice

Davis et al., 2006

Dr. Maria HUNG
13 The principle of respect for
autonomy
 Has only prima facie standing, and
competing moral considerations
sometimes override this principle
 Do not extend to persons who cannot
act in a sufficiently autonomous manner

Beauchamp & Childress, 2013

Dr. Maria HUNG

14
Respect for Autonomy in
Health Care
Include:
 Obtaining informed consent for treatment;
 Facilitating and supporting patients’ choices
regarding treatment options;
 Allowing patients to refuse treatments;
 Disclosing comprehensive and truthful
information, diagnoses, and treatment
options to patients;
 Maintaining privacy and confidentiality.
Butts & Rich, 2013

Dr. Maria HUNG

15
Autonomy - Informed Consent

 Legal & ethical issue of a patient’s treatment

 To make personal choices based on
appropriate appraisal of information about
the actual and /or potential circumstances
of a situation
 3 basic necessary elements:
Receipt of information
Consent for treatment must be voluntary
Persons must be competent

Dr. Maria HUNG Butts & Rich, 2013

 Informed Consent
Examples

Consent for Treatment & Refusal of Treatment Forms

Cultural Considerations with informed consent
Informed Consent for Research Participation
16

Dr. Maria HUNG

17 The Principle of Non-
maleficence
 Includes obligations to:
Not to harm others
Who will be the judge?

Davis et al., 2006

Dr. Maria HUNG
18 The Principle of Beneficence

 Includes obligations to:

Promote well-being of others, or
To act for the benefit of others

Davis et al., 2006

Dr. Maria HUNG
19 Distinction between
Nonmaleficence and Beneficience
Nonmaleficence
 One ought not to inflict evil or harm
Beneficience
 One ought to prevent evil or harm
 One ought to remove evil or harm
 One ought to do or promote good

 Nonmaleficence may override beneficence

Beauchamp & Childress, 2013, p.15

Dr. Maria HUNG
20 Distinction between
Nonmaleficence and Beneficience
Nonmaleficience
 Requires only intentional avoidance of
actions that cause harm
Beneficence
 Requires taking action by helping

 Sharp distinction between obligations of

refraining from harming and obligations of
helping.
Dr. Maria HUNG
Beauchamp & Childress, 2013,
p.152
21 Rules Specifying the
Principles of Nonmalenficence

 Do not kill.
 Do not cause pain or suffering.
 Do not incapacitate.
 Do not cause offence.
 Do not deprive others of the goods of life.

Dr. Maria HUNG

Beauchamp & Childress, 2013
22 Rules of Beneficence
 Protect and defend the rights of others.
 Prevent harm from occurring to others.
 Remove conditions that will cause harm
to others.
 Help persons with disabilities.
 Rescue persons in danger.

Dr. Maria HUNG

23 Distinguishing Rules of Beneficence
from Rules of Nonmaleficience
 Nonmaleficience
 -ve prohibitions of action
 Must be followed impartially, and
 Provide moral reasons for legal prohibitions of certain
forms of conduct.
 Beneficence
 Present +ve requirements of action
 Need not always be followed impartially, and
 Generally do not provide reasons for legal
punishment when agents fail to abide by them

Dr. Maria HUNG

24 Paternalism

 A form of beneficence
 some people believe they know what is best
for another and make decisions for the
person's best interest
 Occur due to one’s age, cognitive ability and
level of dependency

Pozgar, 2016
25 Medical Paternalism
 Involves making decisions for patients who
are capable of making their choices
 Selectively telling the patient what he or she
prefers based on their personal beliefs
 Conflict between autonomy and
beneficence

Pozgar, 2016, p.17

26 The principle of justice
 Includes obligations to:
Treat others fairly;

Equals must be treated equally, and

unequals must be treated unequally

Davis et al., 2006

Dr. Maria HUNG
27
Principle of Justice in Healthcare

 Refers to fairness, treating people equally

and without prejudice, & the equitable
distribution of benefits and burdens
 Difficult healthcare resource allocation
decisions:
Who has a right to health care,
how much health care a person is
entitled to, who will pay for healthcare
costs

Dr. Maria HUNG

Butts & Rich, 2013
28 Scarce Resources

 What happens when resources are

scarce and only one of two patients can
be treated?
 How limited resources should be
allocated?
 What should be the determining factors?

Dr. Maria HUNG

Scarce Resources

Who will get a heart

transplant?

Who should be treated first in

disaster situation?
30 Key Summary

Dr. Maria HUNG

31 Suggested Readings

 Aacharya, R. P., Gastmans, C., & Denier, Y. (2011).

Emergency department triage: an ethical analysis. BMC
emergency medicine, 11(1), 16.
 Butts, J. B., & Rich, K. L. (2013). Nursing ethics: Across the
curriculum and into practice. Jones & Bartlett Publishers.
 Pozgar, G. D. (2016). Legal and ethical issues for health
professionals. Jones & Bartlett Publishers. Chapter 1.

Dr. Maria HUNG

32 References
 Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency
department triage: an ethical analysis. BMC emergency medicine,
11(1), 16.
 Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics
(6th ed.). USA: Oxford University Press.
 Butts, J. B., & Rich, K. L. (2013). Nursing ethics: Across the curriculum and
into practice. Jones & Bartlett Publishers.
 Davis, A. J., Fowler, M. D. & Aroskar, M. A. (2010). Ethical Dilemmas &
Nursing Practice. (5hth Edition). Prentice Hall.
 Davis, A. J., Tschudin, V., & De Raeve, L. (2006). Essentials of teaching
and learning in nursing ethics: perspectives and methods. Elsevier
Health Sciences.
 Pang, S. M. C., Wong, T. K. S. and Yahiro, M. "The Ethics of Healthcare Practice: Being
Good and Doing Harm." Professional Ethics: Education for a Humane Society. Vol. 25.
No. 43. Cambridge Scholars Publishing in association with GSE Research, 2012. 25-43.
 Pozgar, G. D. (2016). Legal and ethical issues for health professionals.
Jones & Bartlett Publishers.
 Slowther A, Johnston C, Goodall J, Hope T (2004) A practical guide for clinical ethics
support. The Ethox Centre. Section C: Ethical Frameworks.
 Wong, D. S. Y. (2010) Legal Issues for the Medical Practitioner. Hong Kong: Hong Kong
University Press.

Dr. Maria HUNG