FOUR

PRINCIPLES APPROACH TO ETHICS

At the end of the session, the students should be able to:

1. State the difference principles
2. Explain implications in health care
3. Apply the principle to health care issues
4. Determined if action is violation or non-violation of the principles
5. State the role of health professionals in relation to the principles.

Rules for health care ethics can be formulated by reference to the four principles
These principles are starting foundational points in health care ethics not solely sufficient or
final appeal.


A. Beneficence

Our obligation to do good is somehow limited by certain factors. Note that physicians cannot
profess to do more than their particular education and skill permit, nor can they do more than
the patients agree to. Most of all, we are limited by our obligation to avoid evil.

In the context of healthcare, it is essential to consider principles of beneficence and
nonmaleficence together. The traditional moral obligation of medicine is to provide net benefit
to patients with minimal harm- beneficence in the context of nonmaleficence. This is because
whenever we try to benefit others we inevitably risk harming them. It is nonetheless important
to retain the two principles as separate ones precisely for those circumstances in which we
have no obligation of beneficence to others --- for we will still have no obligations not to harm
them.

B. NONMALIFICENCE

This principle states we ought not to inflict evil or harm. It is related to the allowing human
rights.

1. Right not to be killed
2. Right not to have bodily injury or pain inflicted to oneself.
3. Right not to have ones confidence revealed to others.

Implications

X should not harm Y

Y has to give due care in dealing with Y so that no harm is inflicted on Y.

Violations

1. Physically harming person

- suicide, abortion, infanticide

- mutilation, torture, violence

2. Exposing a person to physical harm

-subjecting a person to unnecessary treatment or dangerous procedures without

- important goal.
3. Harming a persons reputation, honor, property or interest or by revealing confidential
information.

PRINCIPLE OF DOUBLE EFFECT
- Provides that a person may perform an act which has or risks evil effects if all
four of the following conditions are verified.

1. The action itself is good or indifferent.
2. The good effect and not the evil effect is the directly intended by the agent.
3. The good effect is not produced by means of the evil effect. The good effect must follow the
action at least as immediately as the harmful effect.
4. Theres a proportionate reason for permitting the foreseen evil top occur.

The principle of double effect justifies some actions as nonviolations of the principle
nonmaleficence. Following this principle, when an action is seen to have both beneficial and
harmful consequence, the four conditions must be met to justify what otherwise would appear
as violations.

Role of Health Professional
- Must possess knowledge, skill and diligence

PRINCIPLE OF LEGITIMATE COOPERATION

- is an application of double effect to the situation where an act is performed by
the more than one person with difference purposes
1. Formal Cooperation



- occurs when one assents to the evil intention of the person mainly responsible for

performing the evil action.

- If one advises, encourage, or counsels the person principally responsible for the
evil action.

2. Material Cooperation

- If one becomes involved in an evil action without having the same intention of
the evil does:

a. If ones actions contributes to the active performance of the evil actions so
much so that the evil action could not be performed without the help of the
cooperator.

b. Mediate Material Cooperation

1. If ones cooperation is not needed in the performance of the evil action, but
only assists in the performance of the action.

2. May be justified if there is a serious reason for it because the action on the
part of the cooperator is fundamentally good.


Material cooperation which is sinful deeds of others is, in general, illicit and if permissible
always requires a grave reason. As general rule material cooperation is lawful if it is done in
order to avoid a proportionately grave detriment to oneself or other persons close to oneself.
One must take into considerations of the following:

a. The gravity of other sin. Therefore, a greater reason is demanded for cooperation in home
than in theft.

b. The closeness of the sinful act. Thus a greater reason is required to unlock the door of a safe
to a rubber than to lend him a car for his robbery

c. The indispensability of the cooperation. The more certain the sin that will be committed
without ones cooperation, the lesser a reason is required for ones aid e.g. when selling whisky
to a drunkard.

d. Ones obligations to prevent the wrongdoing. A night- guard in factory has a greater
obligation to safeguard the property than a simple worker.

C. AUTONOMY.
- Obligation to respect the decisions- making capacities of autonomous person.
- Moral right to choose and follow ones own plan life
- Actions and choices should not be constrained by others

Implication:

X has right to determined what will be done to him.

Y has a duty not to constrains Xs autonomous choices and actions.

Violations

1. Actions performed that constrain a persons capacity to make a decisions.
2. Actions performed that constrain a persons capacity to act according to his decisions.

Nonviolations

1. A person expresses his autonomous wish to waive consent or delegate authority to others.
2. competence to give consent is absent or reduced and the procedure considered is necessary
to save the persons life.
3. Respecting a persons autonomy competes with other moral principle; autonomy, vs.
nonmaleficence.

When theres danger that respecting a persons autonomy may harm or impose unfair burden
on another, then the principle of autonomy is overruled by the principles of nonmaleficence.

Role of Health Professionals

1. Provide information necessary to weigh risk and benefits.

2. State his own convictions and clearly explain the reason for his opinion.
3. Dont exercise coercion, manipulation, undue influence or irritations persuasions.
4. Respect patients autonomous choice.

Following the principle of autonomy, a necessarily condition prior to any action (diagnostic,
therapeutic or research) that would affect a persons physiological psychological or normal
integrity is the persons informed consent. The principle of autonomy demands that a health
care provider not treat a patient without informed consent of the patients surrogate except in
narrowly defined emergencies.

D. JUSTICE

- Obligations of fairness in the distribution of benefits and risks.

- One acts justly towards a person when he gives that person what is his due.

Implications:

1. Each individual should receive what his due by right such as:

-Life, information for decisions- making, confidentiality of information.

2. Benefits should be justly distributed among individuals such as:

- Minimum health care, equal opportunities for scarce resources

3. Each individual should share in the burden of health and science such as:

Violations:

1. Denying a benefit to which a person has a right.
Ex; Withholding life-saving medications.

2. Distribution a minimum health unequally.
Ex. Providing selected individuals with available safe water.

3. Imposing as unfair burden to an individual
Ex. Using the underprivileged as research objects.

Non violation

1. The patient chooses to give up what is due.
Ex. Chooses not to be told of the risk involve in treatment.

2. The patient loses his right to what is due.
Ex. Smokes refuse to care for their health, lose right to free health care

3. The patient chooses to accept an additional burden.
Ex. Volunteers to be a research objects.

4. When what appears to be an adjust outcome results from a just process.
Ex. Lottery among all suitable candidates for an available kidney the richest candidate wins.



QUESTIONS:

1. How does a patient practice autonomy?
2. Under what circumstances autonomy may be over ridden?
3. How is justice applied when dealing with patients?
4. How does one apply nonmaleficence when in conflict with autonomy.?