2.1 - Principles of Healthcare Ethics

justice, autonomy, nonmaleficence, and beneficence

4 PRINCIPLE OF HEALTHCARE ETHICS

Nonmaleficence (Do No Harm)

is the duty to avoid causing harm to others, either through actions or omissions.

Hippocratic ethical teaching “first do no harm, benefit only”

relates to the first part of this teaching and means “to do no harm”

In healthcare ethics, there is no debate over whether we want to avoid doing bad or harm. However, the debate occurs when we consider the meaning of the word harm

“first do no harm, benefit only”

Hippocratic ethical teaching ___________-

consequentialist

would say that harm is that which prevents the good or leads to less good or utility than other choices.

natural law ethicist

would say that harm is that which is opposed to our rational natures, that which circumscribes or limits our potential.

deontologist

would say that harm is that which prevents us from carrying out our duty or that which is opposed to the formal conditions of the moral law

virtue ethicist

– a person seeking eudaimonia, a person of practical wisdom – would find that harm is that which is immoderate, that which lead us away from manifesting our proper ends as humans

ethical egoist

would define harm as that which is opposed to his or her self-interest

harm

is anything that worsens a patient’s condition, but defining it isn’t always simple.

HARM as NEGLIGENCE

Healthcare workers follow many protocols to protect patients, families, and themselves.

Not following these protocols is considered negligence, which is an act of omission (failing to do something), rather than an act of commission (actively causing harm).

This is seen as a failure to meet the expected standards of care in their role.

HARM as VIOLATION OF AUTONOMY

If a person elects not to receive a treatment because of a loss of life quality, then may people believe that imposing the treatment on that person is wrong?

This would violate the principle of autonomy and evidence paternalism. Using the principle of autonomy, persons own their lives

pater

paternalism comes from the Latin “________”, which means “father”

Paternalism

by definition, means that one treats the patient as one would treat a child

BENEFICENCE (Benefit Only)

is the duty to actively promote good, improve well-being, and help others.

The other part of the Hippocratic ethical dictum is “benefit only” . The principle of _

______- addressed this dictum.

implies more than just avoiding harm. It suggests a level of altruism that is absent from simply refraining from harm.

bene

comes from the Latin term for “well” or “good”

ethical egoism

the belief that our primary obligation is to ourselves and that selfishness is a virtue

Autonomy (Respect Individual Choices)

- is the principle that individuals have the right to make their own decisions about their lives and bodies.

as a concept means that the person is self-ruling.

Therefore, the physician must treat people’s illnesses, not to judge them for why they are ill.

means having the freedom to choose, but being competent and free from coercion are also important aspects of it

auto

is from the Greek and means “self” .

nomos

which means “rule” or “law”

Injustice

means unfair treatment, which happens when similar situations are treated differently.

Based on Aristotle's idea of justice, we should treat similar cases the same, unless there is a good reason to do otherwise.

procedural and distributive

There are two main types of justice:

Procedural justice

asks if fair processes were used and followed.

It can be defined as “due process” .

means that when you get your turn, you receive the same treatment as everyone else. One can apply this concept to health care.

concerns the fairness of the processes used to make decisions, regardless of the outcome. It ensures that rules, policies, and procedures are applied consistently and transparently.

distributive justice

focuses on how resources are allocated.

It relates to determining what is fair when decision makers are determining how to divide burdens and benefits

means everyone should share equally in the benefits and burdens, unless there's a good reason to treat them differently

concerns the fair allocation of resources, benefits, and burdens in society. It ensures that people receive what they deserve based on need, merit, or equality.

deserving something or needing it

The reasons for discrimination usually fall into two categories:

Justice (Fairness and Equality)

- is the principle of fair treatment, ensuring that resources, opportunities, and rights are distributed equitably.

Ethical theories

provide different frameworks for determining what is morally right or wrong.

Deontology

particularly Kant’s Categorical and Practical Imperatives, emphasizes duty, universal moral laws, and respect for human dignity.

utilitarianism

whether Act Utilitarianism (which evaluates individual actions) or Rule Utilitarianism (which follows general principles), focuses on maximizing overall happiness.

Virtue Ethics

rooted in Aristotle’s philosophy, shifts the focus from actions to character, emphasizing the development of moral virtues for a good life.

Normative ethics

is the study of what is right and wrong

examines ethics theories and their application to various disciplines, such as health care. In health care, ethical concepts derived from normative theories, such as autonomy, beneficence, justice, and nonmaleficence, often guide decision-making

metaethics

is the study of ethical concepts

Authority-based theories

can be faith-based, such as Christian, Muslim, Jewish, Hindu, or Buddhist ethics. They can also be purely ideological, such as those based on the writings of Karl Marx (1818–1883) or on capitalism

Natural law theory

as considered here, uses the tradition of St. Thomas Aquinas (1224–1274) as the starting point of interpretation. The key idea behind natural law is that nature has order both rationally and in accordance with God’s wisdom or providence.

The right thing to do is that which is in accord with the providentially ordered nature of the world

Egoistic theories

argue that what is right is that which maximizes a person’s self-interest. Such theories are of considerable interest in contemporary society because of their relationship to capitalism.

However, the ethical approach of all healthcare professions is to put the interests of the patient above the practitioner’s personal interests.

Egoism

operates from the premise that people either should (a normative claim) seek to advance solely their self-interests or (psychologically) this is actually what people do.

eudaimonia

“happiness”