BIOETHICAL PRINCIPLES:

Autonomy & Justice

Objectives:

• State the principles of autonomy and

justice and their basis
• State the implication/importance of the
principle to health care
• Enumerate their violations
• Enumerate their non-violations
• Discuss the role of the health
professionals in relation to the
principles
Principle of Autonomy

• Autonomy is the moral right to choose

one’s own plan of life.

• Autonomy is based on respect for

person.
• Implications:

X has a right to determine what will be

done to him.

Y has a duty not to constrain X’s

autonomous choices and actions.
Violations:

• Actions performed that constrain a

person’s capacity to make a decision.

Ex. Not telling a patient the risks

involved in an intervention
recommended and
therefore preventing him
for properly weighing risks
and benefits
• Actions performed that constrain a
person’s capacity to act according to
his decision.
Non-Violations:

• A person expresses his autonomous

wish to waive consent or delegate
authority to others.

Ex. A patient explicitly tell his

physician to “do whatever you
think is best,” and not expect
to be asked permission for every
procedure done.
• Competence to give consent is absent
or reduced and the procedure is
necessary to save a person’s life.

• By reason of paternalism (those who

know best decide), the health
professional can decide that the
amount of benefit offered by the
procedure outweighs the loss resulting
from failure to respect autonomy.
Ex.A child in a life/death emergency
situation, cannot give consent for
surgery. The doctor may decide
surgery is necessary to save the life
of the child and proceed without
consent.
• Respecting a person’s autonomy
competes with other moral principles or
autonomy vs. non-maleficence.

• When there’s danger that respecting a

person’s autonomy may harm or
impose unfair burden on another then
the principle of autonomy is overruled
by the principle of non-maleficence.
Ex. If a patient autonomously chooses
not to be confined for homicidal
tendencies and endangers the lives
of others the doctor may use undue
influence to force him to be
confined.
Role of the Health Professionals

• Provide information necessary to weigh

risks and benefits
• State own conviction and clearly
explain the reason for this opinion
• Don’t exercise coercion, manipulation,
undue influence, or irrational
persuasion
• Respect the patient’s autonomous
choice
• Withdraw from the case and help the
patient find another health professional
who might be more successful in these
situations when the health professional
feels it is impossible to help the patient.
Principle of Justice

Justice, also termed fairness, means to

give to each one what he deserves or
what is his due.
What is due is determined by:

• Criterion of what he • Balancing of

deserves by right or competent claims of
rights granted to others against a
him by law person’s claim
according to some
Ex. Right to life morally relevant
merit
Ex. Donating a
kidney to one
who needs it
most
Categories of the principle of
Justice
• Formal Principle of
Justice - no matter which
relevant respects
- equal ought to be are under
treated equally and consideration,
unequals may be persons equal in
treated unequally those respects
should be treated
equally
• Material Principle of Justice

- identifies a particular property such as

need, effort, or merit on the basis of
which burdens and benefits should be
distributed and excludes other
properties
Implications:

• Each individual should receive what his

due by right such as:

a. life
b. information needed for decision
making
c. confidentiality of private
information
• Benefits should be justly distributed
among individuals such as:

a. minimum health care

b. equal opportunities for scarce
resources
• Each individual should share in the
burden of health and science such as:

a. caring for his own health

b. caring for the health of others
c. participating in health/science
progress
Violations:

• Denying/withholding a benefit to which

a person has a right.

Ex. Withholding life-saving medications

from one who needs them
• Distributing a minimum health benefit
unequally.

Ex. Providing selected individuals with

available safe water
• Imposing an unfair burden on an
individual

Ex. Using the underprivileged as

research subjects
Non-Violations:

• The patient choose to give up what is

due.

Ex. Patient asks not to be told of the risks

involved in a recommended treatment.
• The patient loses his right to what is
due.

Ex. Because smokers refuse to care for

their health, they might be
considered responsible for their
chronic ling disease and lose their
right to at least, free health care.
• The patient chooses to accept an
additional burden.

Ex. He volunteers to be a research

subject for a study not directly of
benefit to him.
• When what appears to be an unjust
outcome results from a just process.

Ex. In a lottery among all suitable

candidates for an available kidney,
the richest candidate wins.
Role of the Health Professional

• Give each patient what is due:

available care he needs, information
and confidentiality.

• Provide equal health care to all patients

without discrimination.
• Work toward just health care policies
such as the delivery of minimum health
care to all according to their needs.

• Avoid giving undue burden to

individuals: abusing the poor by using
them as learning materials
Acknowledgement

Powerpoint presentation slides by:

Milagros F. Neri, MD, MA, MPH

Dept. of Community and Family Medicine
Far Eastern University-Nicanor Reyes Medical Foundation
Fairview, Quezon City, Philippines