Universal Principles of

Biomedical Ethics
 AUTONOMY

From Greek word autos (self) and nomos

(governance).
Self-determination

3 Elements
1. The ability to decide.
2. The power to act on your decisions
3. A respect for the individual autonomy of others.
 AUTONOMY

Informed consent
> elements of disclosure
> understanding
> voluntariness
> competence
> permission giving
 AUTONOMY

Legal Exceptions to the Rules of Informed Consent <

Therapeutic Privilege>
Cases of emergency
Incompetence
Waiver
Implied consent
 AUTONOMY

Therapeutic Privilege
Benevolent Deception
Paternalism
Fiduciary Relationship
 VERACITY

Binds the health practitioner and the patient in an

association of truth.
When faced with situations in which lying seems a
rational solution, other alternatives must be sought.
The harm to patient autonomy and the potential loss
of practitioner credibility makes lying to patients a
practice that in almost all cases should be avoided.
 VERACITY

Justification of Paternalism
1. The lie benefits the person lied to: that is, the lie
prevents more evil than it causes for that
particular person.
2. It must be possible to describe the greater good
that occurs.
3. The individual should want to be lied to. If the
evil avoided by the lie is greater than the evil
caused by it, a person would be irrational not to
want to be lied to.
4. Assuming equal circumstances, we would always
be willing to allow the violation of veracity.
 BENEFICENCE

Term that suggest acts of mercy and charity

expanded to include any action that benefits another.
The obligation to help imposes on healthcare
practitioners the duty to promote the health and
welfare of the patients above other consideration,
while attending and honoring the patients personal
autonomy.
 BENEFICENCE

Is the restoration of life that appears to have no value

to the individual, beneficence?
Are the staggering fiscal and emotional costs
justifiable?

* With modern medicine, in which technology often

overwhelms resources, it has become necessary to
use cost-benefit ratio analysis to determine where
beneficence ends and maleficence begins.
 NONMALEFICENCE

Dinstinction between Nonmaleficence and

Beneficence offered by T. Beauchamp and J.
Childress.

Nonmaleficence Beneficence
1. One ought not to inflict 1. One ought to prevent evil
evil or harm. or harm.
2. One ought to remove evil
or harm.
3. One ought to do or
promote good.
 CONFIDENTIALITY

A patients basic right to expect the information he

gives a health care practitioner to be held
undisclosed.
An important aspect of the trust that patients place
in health care professionals.
 CONFIDENTIALITY

Instances in which Confidentiality is Overridden

< Secrets: On the Ethics of Concealment and
Revelation by Sissela Bok>:
Child abuse
Contagious disease
STDs
Wounds caused by guns and knives
Cases in which identifiable third parties would be
placed at risk by failure to disclose information.
 CONFIDENTIALITY

Harm Principle
- a principle that limits the personal protective
privilege of confidentiality.
- requires the hcp to refrain from acts of omissions
that would foreseeably result in harm of others,
especially in cases in which the individuals are
particularly vulnerable to the risk.
 Role Fidelity

Self-regulation is one of the key elements of

profession. Professional code of ethics are important
documents in the process of self-regulation.
Under no circumstances may the practitioner place
his financial interests above the welfare of his
patients.
The primary objective of the hcp is to render service
to humanity. Reward or financial gain is a
subordinate consideration.
 Role Fidelity

All clinicians must understand and remain within

the constraints of their professional practice act.
Gatekeeping within role duty and fidelity requires
the individual practitioners be responsible not only
for their standard of practice but works to protect the
community, patients and our specialties from abuse
of other practitioners.