CHAPTER

ETHICAL PRINCIPLES
PRINCIPLES

PART II : MORAL PRINCIPLES

Whenever one is asked to recognize where

a position is coming from it is simply trying to
imply the validity of certain ideas. It is when the
framework or paradigm surface which provide
where the persons view is coming from. This is
where principle is needed. What does principle
means?
Principle is that which is describing the
rule or law concerning a phenomenon providing
generalization of a certain truth which can be
used as a basis for reasoning. In the case of
ethics it provides a basis for providing basic
truths, law or assumption that will serve as
standards for good behavior or conduct.
MORAL PRINCIPLES
Moral principles are basic generalizations
containing certain moral truth from which serve
as the basis for the knowledge of a definite moral
background from which performance of numan
actions proceeds.

BASIC ETHICAL PRINCIPLES

The role of moral principles to the human
person therefore is to explain particular moral
truths wherein one action is morally preferred
than the other, not because the person truly
approves of it, but that an action is truly and
genuinely better than another act. Furthermore,
such truth explains why an act should be
preferred more than the other act. Thus, this
truth will serve a s guide in justifying moral
actions.
The following ethical principles that will be
discussed is divided into three sets namely:
Basic ethical principles which cover general
principles applied to human action of any person
regardless of status and profession.
Bioethical principles which discuss the ethical
principles that will guide health are professional
in the practice of improving the quality of life of
human person in the practice of health care
profession.
Constitutive rights of the patient which will
present ethical principle that will protect the
patients, recognizing their right to life and health
care.

Principle of Stewardship
The principle of stewardship defines the
responsibility of the person to take care, nurture
and cultivate what has been entrusted to him.
This may be traced back from the beginning as
told from the story of creation.
In the biblical account of creation, God created
the earth, the whole universe and everything in
it. God create the vegetation, the birds in the sky,
fish in the sea and all the beasts wild and tame.
God describe all His cration to be good. This
implies that the original blueprint of Gods
creation is good. There is one creature of God
which is created unique. He created man in His
own image and likeness.
God created man in His own image, in the image
of God He created him; male and female He
created them
In this regard, God endowed man with gifts
which allowed man to be given dominion over all
creatures. As said the scriptures;
fill the earth, and subdue it; rule over the fish of
the sea and over the birds of the sky and over
every living thing that moves on the earth. Then

God said, Behold, I have given you every plant

yielding seed that is on the surface of all the
earth, and every tree which has fruit yielding
seed; it shall be food for you; and to every beast of
the earth and to every bird of the sky and to every
thing that moves on the earth which has life, I
have given every green plant for food; and it was
so.
However, the authority and dominion given by
God should be put into proper perspective. If we
look at it, God gave man an order, that is, fill the
earth, and subdue it, rule over all creatures, these
imply that the authority given to man is not full
ownership rather to look after what was shared
to him by the creator.
Then the Lord God took the man and put him into
the garden of Eden to cultivate it and keep it.
The dominion in this case is in
the context of stewardship
rather than ownership. Man is
set to be the steward of life
shared to him by God. He is is
endowed man with gifts but
gave him the responsibility to
take
care,
nurture
and
cultivate the first gift given to
him by God, that is life.

As health care professionals, it must be realized

that the major role of the profession is to protect,
promote and develop our life and others a s well.
This imply that we should avoid to inflict harm
rather everyone should respect others This is
true since it is everymans primary role, to be
stewards of life.
Principle of Solidarity
The Principle of solidarity
motivates us to care for the
earth and the greater biocommunity in which we
ourselves are just a part. One
must realize that as stewards
of the land we recognize that
creation is a web of life in
which we all cling together. Therefore one is
responsible to be one with others. In this case,
the authority is correctly "lifted up" to a "higher"
society. When does the principle of solidarity may
be invoked?
The principle of solidarity may be invoked when:

When a group of "inferior societies" must act

in a coordinated way

When a group of "inferior societies" are trying

to kill each other

When one rogue "inferior society" can ruin the

efforts of all the others

Principle of Subsidiarity
The principle of subsidiarity is
a
Catholic
sociological
discipline which recognizes the
capacity of an individual or
smaller group to exercise its
power within their capacity to
achieve its intended goal. This
implies that the higher group
should not interfere on the
individual or small group who perform efficiently
and that could result on taking away the
opportunity to perform its function.
Furthermore, local control and deliberate
participation is encouraged, as long as its
members within the locality are willing and
capable to perform their necessary functions. In
this case the authority is correctly "pushed
down" to "lower" societies
The principle of solidarity may be invoked when:

the "inferior society" is in a better position

to make good decisions.
the "inferior society" would be "infantilized"
or oppressed if the "superior society"
decided for them.
When a very complex situation requires
initiative and flexibility.
When a certain amount of redundancy
gives a more robust system

Principle of Totality
When the whole is being dealt with as the
subject of discussion it is imperative to also look
at parts because the whole implies the existence
of the part as the parts indicates the existence of
the whole. Just as when we say hand, in implies
the presence of the fingers and the palm. Remove
the fingers or the palm or both dissolves
discussion about the
hand. Therefore the
part
becomes
essential when we
talk about the whole.
That is the reason
why when the part
becomes problematic
it affects the whole.

We can also say that when the whole becomes

problematic it is possible that it is caused by
problematic part.
In order to solve the problem of the whole there
are two things to consider:
When the part is problematic and it manageable
then the part must be treated in order to preserve
the whole. On the other hand is the problematic
part poses threat to the whole that would tend to
totally destroy the whole, then it is morally
acceptable to sacrifice the part in order to
preserve the whole. Both conditions are posited
in order to preserve the whole. This is valid
because the whole is far greater than its parts.
The basic capacities which defines the human
personhood , however are sacrificed only when
there is a need to preserve life.
Principle Double Effect
Natural law explains that in every
action there a corresponding equal
reaction and in the principle
human behavior or psychology
there is that which tells that there
is a corresponding reaction to a
certain stimulus. Such reactions

from either a stimulus or an action is referring to

the result or effect of an action which is in itself
could also be a stimulus.
Actions, from the previous discussion may be
good or evil. An intrinsically good act unless
otherwise the motive is evil will have good effect.
On the other hand, an intrinsically evil act will
produce evil effect. There is no problem the with
good act that produces good effect. The dilemma
of the good act is that if the act produces both
good and evil effect. Will this change the nature
of the goodness of the act? Is the act that
produces
good
and
evil
effect
morally
permissible?
The good act that produces two effect, maybe
resolved through the principle of double effect. A
good act that produces good and evil effect is
morally permissible only if the act satisfies all the
following four conditions:
1. The act must be good in itself, or at least
morally indifferent
2. The good effect must come before the evil
effect, or at least the good and evil effect
occur simultaneously

3. There must be sufficient reason for the

performance of an act in the attainment of
the good effect.

2. There must be freedom to choose not to do

act which is the cause of the evil effect.

4. The motive of the agent must be holy and

honest

3. Omission doing the act which the cause of

the evil effect holds the agent morally
bound

All these four conditions must be satisfactorily

fulfilled when invoking the principle of double
effect

If the three conditions are present then the agent

is inculpable to the unintended evil effect of the
act that is willed.

Principle Indirect Voluntary Act

Principle of Cooperation

In the principle of double effect, the good effect is

directly intended as the bad effect is unintended
consequence of the act. However there are
situations when an act which is directly intended
with foreseen evil effect which is not directly
willed. This is when the Principle of Indirect
voluntary Act may be invoked.

The
word
cooperation
came from two latin words,
Cum which means with
and operari which means
to operate or to work.
Looking at the etymology
of the word defines that
the cooperation means to
work with which implies
that involves the work is
done between persons.

This happens if an act is necessary to be done

but will obviously will produce an evil effect, or
an either when committed or omitted will tend to
have evil effect. The dilemma in this situation
may be resolve fy the principle of indirect
voluntary act observing the following conditions:
1. The evil effect must be foreseen or
foreseeable in the performance of the act

The principle of cooperation is defined as working

with another in the performance of an action to
produce a good particular effect. The problem of
a cooperative act arises if the human action
produces evil effect or when the morality of the
act in cooperation becomes in question if the act
is in contrast to right reason and moral law. In
this case, both agents become culpable to the

evilness of the act. However the degree of

culpability varies according to the participation of
each agent
Degrees of Cooperation
Formal and Material
An agent is considered formal cooperator if the
act is willed and intended by the agent. On the
other hand, an agent is a material cooperator
to an act if the agent did not intended the act but
contributed to the achievement of the act and its
effect. A formal cooperator has greater culpability
to the effect of the act.
Direct and Indirect
A direct cooperator has an actual involvement
in the performance of the evil act therefore a
direct bearing to its effect. The agent may not be
the one who planned the act however has
executed the planned action. An indirect
cooperator is the agent who is not connected in
the performance of the act but may have bearing
upon the effect. A person who has knowledge of
a planned act and has the capacity to prevent the
evil result but did not do anything to prevent the
evil effect to happen is likewise culpable.

Proximate and Remote

Proximate cooperators is culpable to the
evilness of the act due to close bearing,
knowledge or physical presence during the
execution of the act. On the other hand remote
cooperator are those agent who has distant
connection with the execution of the evil act.
The principle of cooperation suggests that no one
should formally and directly cooperate in the
performance of the evil action since the agent is
directly connected to the performance of the act.
However Sufficient grave reason may morally
excuse the agent who materially cooperates with
the evil act. Likewise, proximate material
cooperator may only be excused if the sufficient
grave is preventing greater harm to occur.
BIOETHICAL PRINCIPLES
Principle of Inviolability of Life
In an earlier discussion about the human person
we have learned that the human person is
created in the image and likeness of God. For this
reason man earned his dignity. Man was given
the first gift which is life, a gift which came from
God and for this reason it is sacred. The dignity
and sanctity of human life earned the human

person the right to be respected. This is what

principle of inviolability of life is referring to, the
sanctity, dignity or respect for human life.

Violence in any form

Human life is not just a

mere idea rather, it is a
concrete reality which is
lived and acted, it grows
and develop, capable of
love
and
service
to
humanity. Human life is
an expression and fruit of love precious that No
amount of money can surmount its cost because
It is a gift from God which is forever. For these
reasons, a persons right to life from the period of
conception should not be violated because it is
likewise violating the moral order which is life
itself.

Drug and alcohol addiction

Human life in itself is sacred. It must be affirmed

cherished, respected, defended and preserved.
Life should not be violated, opposed and
destroyed and health professional should be
committed to it. That is to choose life and fight to
protect it which presuppose that the commitment
to life overcomes commitment to death. This
includes being against

Pollution of environment

Treachery in human relation

Principle of Beneficence
The
principle
of
beneficence refers to a
normative statement of
a moral obligation to
act for the benefit of
others, helping them to
further their important
and legitimate interests It connotes acts of
mercy,` kindness, and charity, which suggests of
altruism, humanity, and promoting the good of
others.
The principle suggest that doing good for others
is not limited as a requirement of a function but
as a moral obligation which requires a health
care professional to perform his duty to preserve
life, maintain the physical integrity and health of
the patient and improve the quality of their lives.
A health acre professional should ensure that all
aspect of the human person is given , catering all

the needs of the client Thus, the service a health

care professional provides is the total self-giving
which is an act of love.
Although it is a natural tendency for a sick
person to seek treatment at once it is likewise iis
therefore a duty of a health care professional to
provide beneficent intervention by attended to to
the medical need by stemming the bleeding,
mending the broken or suturing the wounded.
The action come from a benevolent spirit in
providing beneficent treatment that in the health
care professionals mind is to serve the best
interests of the patient.

Negligence occur if the professional the

professional has breached the duty to the
affected party resulting the patient to experience
harm.
The following are some violations of the principle
of Non-maleficence:
Physically harming the person
Exposing the person to physical harm
Harming the persons reputation
Placing the human person in sub-human
condition
Degrading working conditions

Principle Non-maleficence
The principle of non-maleficence requires a
health care professional not to intentionally
create a needless harm or injury to the patient,
either through acts of commission or omission. It
is obvious that anything that harms the person
and his dignity in all aspects is a clear violation
of this principle and anyone who imposes a
careless or unreasonable risk of harm upon
another is negligent of his/her duty.

Principle of Justice
Justice is one of the virtues that allow man to
respect the rights of each other thereby
establishing
harmonious
relationship
and
promoting equity between them and the common
good. For Aristotle, justice is giving to each that
which is his due." It is defined in the context of
equality, fairness and equity and implies fair
distribution of goods in society.

In health care, justice is in the form of fairness

and generally held that persons should qualify
for equal treatment regardless of age, gender,
sexual orientation, class, race etc. In order to
apply justice in any scenario, individual factors
should be examined on their own merit. Each
scenario is unique and should be addressed
accordingly.
We should recognize
that the resources
are
finite
and
therefore
limited.
There are limits to
the funds, supplies
and
even
health
services. For this reason fair means of allocating
these scarce resources must be determined in
order to have fair distribution of goods in society.
That is why in health care distributive justice
prevails which the concern focuses on who gets
what treatment in healthcare, and who decides
what treatments are administered. The decision
is based on needs and the factors as a criteria for
distributive justice, including the following:

to each person an equal share

to each person according to need
to each person according to effort

to each person according to contribution

to each person according to merit
to each person according to free-market
exchanges

Social justice as well as solidarity compliments

this principle. Society ought to help even the
playing field by providing resources to help
overcome the disadvantaged situation. However
most often than not even if the process is just
although the outcome may not appear just. There
is seemed to be collision of rights. This condition
requires consideration to all the rights of
individual which complicates attention that
according to one right would violate the other.
There are two alternative operations that could
be used as a basis to decide and to minimize
complications due to the collision of rights. There
are opportunities in both operation, however
there are threats as well
Utilitarian Alternative
This alternative would tend to maximize all
possible means in order to achieve the greatest
good and greatly minimize potential evil/harm
Medical Success principle - attention should be
given to the one which has greater chances of
survival

Example: The available rare blood type

supply will be given to a patient who is a
victim
of
vehicular
accident
and
experienced heavy bleeding than the
patient suffering from multiple organ
failure.
Immediate usefulness- health care is given to
the one which will be more useful to add relevant
service to the situation
Example: If there is a war, the soldiers
must be given priority in health care rather
than those who are having an executive
check up.
Principle of conservation - This would be more
applicable when there are limited medical
resources. In this situation, supply must be
distributed evenly so that everyone may be given
a share of the available resources.
Example: In a medical mission starter dose
may be given rather than the complete
treatment doses in order for the other
patients to have s share of the free
medicine.
Parental role principle - This principle sets priority
to the one which has the greater dependents or
people relying on the person.

Example: A lactating mother should be

given the priority to the available vitamins
than a single woman who needs it.
Principle of general social value - In this case the
attention is given to the person who plays a
greater role in the society.
Example: The president of the country
deserves priority in the treatment rather
than an ordinary citizen
Egalitarian Alternative
Is an alternative is employed is more concerned
on maintaining or restoring the equality of person
in need
Principle of saving no one this do not give
priority to any one. This operates on the idea that
in order to minimize conflict then no one should
benefit from the resources.
Example: In an a uncontrolled crowd who
is running after a free medicine , the
solution is not to have free medical
privileges rather everyone will need to buy
the medicine from the drug store.

Principle of medical neediness This principle

operates in giving priority to the patient requiring
immediate medical attention.

Example: to determine who will be the first

to get the medical attention, drawing lots
may be employed.

Example: A patient who is more ill should

be given priority to medical attention rather
than those experiencing simple ailments.

It is necessary to note that there is no perfect

alternative to operate as absolute solution to the
conflict of rights. However these are just some
alternative that may be employed depending on
what the situation calls for or what the health
care professional judges as just in the given
situation.

Principle of general neediness In this situation

the priority is given those which has more
pressing
needs
or
to
those
who
are
underprivileged.
Example: Available health care resources
should be given to those who are poor
regardless whether they have the needs or
not.
Principe of first come, first served basis the
priority for health care attention is given to those
who arrives first.
Example: The doctor would attend to the
person who registered first and allow the
next to wait for its turn regardless of the
need of the patient.
Principle of random selection this operates in the
principle of chance and apparently based on
luck.

It is therefore fitting to define two moral

elements that will distinguish the power and
responsibility of a human person.
The principle of justice is observed through the
discharge of duties and obligation with respect to
the right of the patient.
Right vs Duty
Right is inherent to
human
nature
and
dignity. It
is a moral
power of performing of
possessing or requiring
something what is due. It
is founded on law to
which it has to be exercised under conditions

which is to be respected and not to be violated.

Hence justice is a matter of conformity to the
principles of right as enjoined by natural law and
positive law.
On the other hand duty is the moral obligation
inherent to the person needed to be done or
omitted.
Example: It is the right of any human
person to receive health care regardless of
status and competence. While it is the
duty of the health care professional to
attend to the needs of any human person
who demands health care.
Health care practice is both a right and a duty. It
is the right of the health care professional to
practice the profession by virtue of his/her
professional competence and it is his/her duty to
provide health care by virtue what is demanded
by the same profession. This holds true with
other professions.
The following are the duties of the health care
practitioner towards the patient.
1. preservation of life and health
Prevention and treatment of sickness
Alleviation of suffering

2. respect of bodily integrity from harm

Prevention of unjust mutilation and
sterilization
Subjecting the person to research
3. respect of human dignity.
High regard to person
Right
to
information
and
confidentiality
Palliative care
Despite all the attempt to perform all obligation
in order to provide what due, seemingly there
seemed to be conflict of right. Then we begin to
ask, Which right should prevail?
For example, a conflicting decision of the patient
and the physician. It is the right of the patient to
choose the treatment that is best for him however
it is also the right of the physician to decide what
is best for the patient. Both parties may have
their arguments, the patient being the recipient
of the treatment and the professional being a
competent individual who has the knowledge of
the possible treatment. In cases like this, it is
best to examine the condition in order to arrive a
morally sound solution,

Condition for Greater right

1. Universal Order
2. Concerned with greater matter
3. Stronger title or claim
4. Order of Good
5. respect for the person
6. social well-being and development
7. Peace(the stability and security of a just
order)