BIOETHICAL PRINCIPLES: Autonomy & Justice

Principle of Autonomy

Autonomy is the moral right to choose ones 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 Xs autonomous choices and actions.

Violations:

Actions performed that constrain a persons 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 persons 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
persons 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 persons autonomy competes with other moral principles or autonomy vs.
non-maleficence.

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 principle of nonmaleficence.

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

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Provide information necessary to weigh risks and benefits

State own conviction and clearly explain the reason for this opinion
Dont exercise coercion, manipulation, undue influence, or irrational persuasion
Respect the patients 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 deserves by right or rights granted to him by law

Ex. Right to life

Balancing of competent claims of others against a persons claim according to some

morally relevant merit
Ex. Donating a kidney to one who needs it most

Categories of the principle of Justice

Formal Principle of Justice
- equal ought to be treated equally and unequals may be treated unequally
- no matter which relevant respects are under consideration, persons equal in 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 Professionals

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