PHI 15 Vocabs & Principles

what is bioethics and when did it emerge?

the interdisciplinary study of ethical, legal, and social questions arising from advances in medicine, research, and technology; emerged in 1950s - 1960s

What is principlism?

the dominant approach/framework in bioethics that guides moral decision-making by applying four core principles.

• it is the product of human history and experience, learned and transmitted through the generations

Who developed/proposed the framework of Principlism?

Tom Beauchamp and James Childress —in they seminal textbook, Principles of Biomedical Ethics (9th Ed), 2026

What are the 4 foundational principles of morality in bioethics?

1. Respect for autonomy

2. Non-maleficence

3. Beneficence

4. Justice

What does respect for Autonomy mean?

autonomous = self-determining

means

• we can think for ourselves (choose to do smart or dumb things)

• we are able to self-legislate (make decisions about the past, present, and future, by self-reflecting, w/o having someone imposed on us from the outside —by others or circumstances

What does Respect for Autonomy emphasize?

recognizes a pt’s right to self-determination, voluntary decision-making, and informed consent to be able to choose what’s best for themselves

• providing advice and assisting in understanding the best course of action elf action (for an ind.) to assert their autonomy

  • persuading ≠ informed consent (deception/ affecting behavior w/ manipulation

  • failing to do so → bodily assault on the pt

What would be an example of practicing the principle respect for autonomy?

the pt choosing what’s best for them medically

what would be an example of violation the principle respect for autonomy?

paternalism

What are rules derived from this principle: respect for autonomy?

• tell the truth

• respect confidential info

• obtain informed consent for interventions w/ pt

• when asked, help others to make important decision

  • pt.s are not entitled to receive interventions that are not medically validated

  • Respect for autonomy in medicine is asymmetrical “anything I do to you as a dr. I need consent (require authority), but respect for autonomy doesn't require me to serve you medically for something you WANT (it needs to be medically validated)

What is it called when a clinician decides what’s best for the pt?

paternalism

what is paternalism?

deciding what’s best for another being w/ assumption that they cannot make the decision for themselves

• I.e. surgeon extracts a cancerous legion that was assumed to be small, but they go in, it’s a lot bigger -> pt gets a full mastectomy

  • This is paternalism which is wrong when we deal with autonomist pts (pts who can advocate for themselves)

• in deep conflict with respect for autonomy

when is paternalism acceptable?

for children (who are minor), for animals (who are non-verbal), and for ind. unable to make a rational decision (cognitively impaired, dementia, schizophrenia, psychosis pts)

what do cases where paternalism is accepted often involve (hint: type of consent)

often involve an assumption of implied consent that in certain situations, the principles of paternalism will come in and decide that the ind. will want certain decisions to be made (i.e. life threatening cases)

what is the common principle that conflicts with respect for autonomy?

beneficence; most of the debates involve conflicts about respecting a person’s autonomy or dignity v. what is in their best interest (medically)

• i.e. Jehovah’s Witness pt in need of a blow transfusion, medically, beneficence include giving them the blood transfusion, but respecting their autonomy would mean not giving them the transfusion

what does non-maleficence emphasize

Require an omission, that you abstain from harming (do no harm) → negative obligation: omitted to NOT do something (NOT take action)

is there exception to non-maleficence (not doing harm)?

yes, i.e. justified amputation of a pt’s leg to save that pt’s life

what does prima facia mean?

first appearances (at first glance, do no harm, if you are going to do harm (take action), need justification, (i.e. how a moderate deontologist may operate → need justification)

what does primum non nocere mean?

“above all do no harm”

what are some rules derived from this principle: Non-maleficence?

• do not kill

• no other cause pain or suffering

• do not incapacitated

• do not cause offense

  • do not deprive others of the goods of life

what’s an example scenario where non-maleficence would conflict with another principle? (hint: non-maleficence v. beneficence)

body integrity disorder:

1. w/ respect to non-maleficence: need for medical validation, might even be prohibited by the rule of “by all do no harm” (negative obligation)

   1. w/ respect to beneficence: can argue for positive obligation: “I have the duty to help you with your consent”, but in this case, the want for this procedure needs to be medically validated

what does beneficence emphasize?

“do good”; do good for others, promote ad contribute to people’s welfare (medical context: promote pt’s heath) and actively prevent people from facing harm (by taking action)

what is it called when there’s a need to take action to obey beneficence?

positive obligation (go out of your way to provide information)

What are rules derived from this principle: Beneficence?

• protect and defend the ints of others

• prevent harm from occurring to others

• remove conditions that will cause harm to others

• help persons w/ disabilities

• rescue persons in danger

what does justice emphasize?

concerns fairness in the distribution of health resources, risks, benefits and treating everyone with the same respect, no bias, and ensuring equitable treatment

• fair distribution of health resources

• fair compensation for participation in research

• fair selection of research subjects

• ending disparities in health care based on race, gender, etc.

• ensuring vulnerable groups are not exploited

• fair procedures for rationing health care (i.e. organ donation)

What is an example case where “fair selection of research subjects” were violated?

Tuskegee Trial

what are some example scenarios where there’s a need apply “fair procedures for rationing health care”?

life-saving resources in pandemic (i.e. vaccine), organ donation, etc.

how is the principle of justice different from the other 3 principles in principlism?

• the other 3 occur at the bedside of the pt, so to speak

• The justice condition is about fair access to resources; it occurs at the population level —across people (assess moral actions across all interactions with/ various party)

What are rules derived from justice?

• “equal persons ought to be treated equally”

  • Simply: “my tx of you should be same unless I have a morally good reason to depart from equal tx”; otherwise, the assumption is, we are all equal and should be treated equally

• don’t discriminate based on gender, race or other morally arbitrary features of a person (i.e. people wearing red shirt)

• don’t take advantage of someone’s poverty of desperation

What to do when principles conflict?

1. making the principles more specific by giving it more rules (that consider special circumstances as well)

   1. i.e. “do no harm” is not very helpful when trying to figure out whether it’s permissible to help a terminally ill person die

what is specification in terms of when principles conflict

making principles and rules more specific and narrowing the scope of norm (add specifics: where, when, why, how, by what means, to whom, by whom)

what’s an example that compares the difference in general rule v. specified rule?

1. general rule: “always obtain informed consent”

2. specification: “always obtain oral or written informed consent for medical interventions w/ competent pts, except in emergencies, in forensic examinations

How to balance the weight of priority of norms? (hint: what did Beauchamp and Childress propose)

1. good resources can be offered to act on the overriding norm rather than on the infringed norm

2. the moral objective justifying infringement has a realistic prospect of achievement

3. no morally preferable alt. actions are available

4. the lowest level of infringement(exposure to public), commensurate with/ achieving th primary goal of the actions, has been elected

   1. i.e. phone call to the restricted parties getting this confidential information; NOT a whole BILLBOARD announcing someone’s health condition

5. all negative effects of the infringement has been minimized

6. all affected parties have been treated impartially

What is Casuistry?

case-base approach that evaluates the case going from bottom-up.

• a bottom-up approach ethical practice

  • consider real concrete case from the past (that’s similar to the current case at hand) → previously derived norms → compare it to the present case at hand → derive norms

  • Much like Common Law tradition

    • based on past/historical cases

    • reasoning is at a case-based lvl, using the wisdom of the past to help

• requires historical knowledge and experience to practice

what are the methods of Casuistry?

1. describing a case in rich detail and categorize the case (broadly)

   1. i.e. termination of life case

2. fit it into a taxonomy of other cases: “a structured reservoir of response to similar cases that contains various paradigm cases of conduct judged to be manifestly right or wrong”

   1. when we have moral certainty, it comes from cases, not in the abstract

3. locate the present case on the spectrum, from unacceptable to acceptable conduct

4. draw a conclusion (ethical choice of procedural)

what’s the difference between casuistry v. principlism (hint: what do bioethicist think of the two)

several bioethicist think that the two approaches complement each other; we still need ethical theory and principles in cases, but casuistry helps up determine how to balance principles in cases of conflict

what are the advantages of casuistry?

• fits well w/ practical reasoning and medicine: dr. are familiar w/ case-based reasoning

• no need for deep theory

• well-suited for consensus in a pluralistic society, the aim is to reach overlapping consensus

• deciding cases at case-level does’t threaten ppl’s deeply held higher lvl principles

what are some criticisms of casuistry?

• it’s inefficiently critical; it states w/ the judgments we already have an analogies from them

• what if those judgments were wrong to begin with?

  • misjudgments were applied in the history; past beliefs that were morally incorrect

• it’s a fundamentally “conservative” approach (has past beliefs, old, which could be biased and wrong)

what is the Nuremberg Code?

• collective statement of ethics and medical professions stating medical practice values

• not legally binding

what did the nuremberg code do for the future of ethics and law?

formed the basis for later ethical and legal documents

what is the 10 major points in the Nuremberg Code?

1. voluntary consent of human subject is essential; informed consent

2. experiment should highlight reasonable argument and focus of research that yield fruitful results for the good of society (not just for curiosity)

3. experiments should be based on non-human subjects first

4. experiments conducted to avoid all unnecessary physical and mental suffering and injury

5. experiment should not be conducted (to a subject that is not the researcher/experimenter themselves) if there are known risks

6. benefits to humanitarian importance outweigh risks from the experiment

7. proper preparations should be made and adequate background knowledge to ensure safety

8. human subject should be at liberty to bring experiment to an end

9. consent also involves allowing subjects to opt-out

10. the scientist in charge must be prepared to terminate the experiment at any stage, if s/he has probable cause to believe that the experiment is harmful to the subject’s health/wellbeing

wha

what was the significance of the Nuremberg code?

• the concept of informed consent to participate in research which holds to this day

• made it a criteria for dr.s/researchers to have social benefit, not for use science or research based, it also express preclinical testing in animals and dr. beneficence to research subject (subject benefits from experiment)

what does the philosophical ethics study?

study what people “should” think is ethical (i.e. religious intentions), these are proposed as (prescriptive) normative statements (more about what they think is (and should be) ethical rather than informing about the perspective of her views in what is considered ethical)

what is a normative statement?

evaluation or judgments or prescriptions or prescriptions (key marker: should, ought, good, bad)

• can be true or false

what is a descriptive statement?

describe the world; they can be empirically verified/flasified

what is the methodology of ethics? how do we decide what should be the (ethical) case?

1. rely on ethical theory that independently makes sense

2. apply them to concrete cases

3. and see what verdict it gives to make sure they get intuitively right results

what is reflective equilibrium?

the balancing of institutions on core cases w/ plausible moral principles to come up w/ a coherent system of ethics

what is consequentialism?

a major moral theory that incorporates some of these key concepts

• only consequences matter, not intentions, motives, act-type, etc.

• they are result-based

• i.e. saving a net of 4 lives out of 5 is better

what does a consequentialist consider is the “right action”?

the act that brings about the best consequences for everyone that is equally accounted for

what is utilitarianism?

a species of consequentialism that defines the good that matters as well-being

what does a utilitarianism consider as the “right action”?

the act that brings about the most well-being for all people considered impartially

what is deontology?

a major theory that emphasizes that morality has limitaitons/restraints, prohibitions on action

• do no harm to others (harm constraint); don’t break our promises, etc.

what is kantianism?

a version of deontology introduced by 18th century philosopher Immanuel Kant that emphasizes the importance of human dignity and autonomyw

what would a consequentialist respond in determining how to distribute organs in organ transplant cases?

the consequentialist would choose the option that yields the most benefit for the majority of the people

• they’re all about being the one to do the GOOD thing to get the greater benefit/results, they don’t care about how their action might bring worse outcome for an ind., b/c their main goal is to get the most benefit for the majority of the people involved

what would a deontologist say about the organ donation dilemma?

choose the option of harming the one pt. to save the 4 dying pts b/c their theory to promote the good will outweigh their ideal to not do any harm

what are the different views a deontologists can have (hint: think smth equivalent to right and left political party)?

absolute and moderate deontologists

what would a absolute deontologist say in. the ticking time bomb dilemma?

they believe that constraint against harm is ABSOLUTE, and cannot be overridden

• says “you can’t kill one person to save all of humanity, that’s morals wrong.”

how are consequentialist and absolute deontologist similar?

both theories are simple: forceful harm constraints (absolute deontologist), they have forceful duty to promote the good (consequentialist), not much more to say

• they bear a very unintuitive theory of morality

how would a moderate deontologist respond to the ticking time bomb dilemma?

they says it depends on the situation but still need justification to take action

• i.e. common sense morality

what is required of moderate deontologist when taking action? (hint: they need to compile smth to make a most ethical decision)

they need to propose an intricate description of tradeoffs representing how much damage (constraints) a particular action would cause on a particular ind. or pop. (weighing the harm against the resulting good), and state the thresholds for each tradeoffs

i.e.

• how many people to justify one innocent person’s killing

• how many saved headaches can justify one punch I the face

what is the limitation to the moderate deontologist view?

sacrifices simple solutions for a broken down principle (intuitiveness); capture concept of common sense morality better but lose rigor of a simple theory

• i.e. constraint against harm, breaking rules, breaking promises

what are the tradeoffs for choosing a consequentialist/absolute deontologist view v. a moderate deontologist view (normative ethics)?

the tradeoff is between a simpler but radical theories (former) v. common sense morality (intuitive), but figuring out the most ethical decision is unclear

what is the John Arras’ Assessment?

prominent American bioethicist whose work centered on evaluating the methods and ethical reasoning used in health care, according to The Lancet and Voices in Bioethics

• heuristic (rule of thumb) for decision-making

• can be supplemented w/ appeal to higher ethical theory

  • going back and forth with other ethicist until all come to a consensus

what are the conditions for informed consent

1. Competence

2. Understanding and appreciation of information

3. Voluntariness

these are all necessary and must be jointly sufficient, meaning if you don’t have one of them you didn’t get informed consent

What is sufficient competence when obtaining informed consent?

• Your pt is competent to assert their autonomy

• Question: can choosing to go against what is medically best for oneself be a sign of one’s incompetence?

  • I.e. many Jehovah's Witnesses reject life-saving blood transfusions

    • This wish is typically respected (b/c they’re judgments are competent)

  • Non-Autonomous pt (children or cognitively incompetent): medical beneficence over autonomy (what saves their life)

• Domain specific: i.e. finances, medical

  • Having competence in one area but not another

what is sufficient understanding and appreciation of information to obtain informed consent?

• most controversial condition

• oftentimes understood as a duty for the clinician to disclose the relevant information, not a duty to ensure understanding

• two big question:

  • How can clinicians ensure understanding? They can’t look inside your head to see if you understand something, So perhaps the focus should be on whether clinicians fulfilled a duty to disclose

  • What information is necessary for understanding? We can’t disclose everything

• A reasonable pt. (person) standard

  1. Information I need to disclose to you as a dr. is the information that any reasonable person would want to know

• Four Disclosure Requirements Necessary (not sufficient) for informed Consent:

  1. The nature of the procedure

     1. Is it an injection, pill, or surgery

  2. Risks of the procedure

  3. Alternatives to the procedure, if any

  4. Benefits of the procedure

• Voluntary: free of coercion, undue influence, manipulation

What is Voluntariness is obtaining informed consent?

Free from…

1. Coercion: threat of harm if one fails to do what another wants

   1. I.e. Prof. Ruli threatens you that if you don’t enroll in her research study, you would fail her course (this is not controversial b/c it’s a no-brainer for almost everyone to say it’s ethically wrong if you didn’t know that these were the conditions to receive good grades in the course)

2. Undue influence: prospect of great benefit if one does what another wants

   1. I.e. Prof. Ruli offers benefit that’ll cloud my judgment (to do smth that I wouldn’t do otherwise): undue influence; this is not threats, and is controversial (grey area with ethics)

      1. Doing risky jobs for fat paycheck (is it undue influence or are people just doing their job → no violation of autonomy like in coercion)

3. Manipulations: i.e. deception

   1. using power dynamics

What are exception to informed consent?

• Emergency waiver: no time to consent

  • some ppl have DNR bracelets

• Waiver: pt. voluntarily and deliberately gives up the right to informed consent. Authorizes physician or surrogate to make decisions for them even if they’re still competent (since they’re still competent they can revolt the waiver)

• *Therapeutic privilege: withholding of relevant information from pt. When it is deemed that the information could harm the pt. by telling them

  • i.e. pt. diagnosed with HIV, if we were to tell them they have HIV, the pt might self-harm

  • has become more and more disfavored and controversial, movement away from this in the last decade+

competence in legal terms

having legal status to make one’s own decisions in a particular area

what are capacity assessments?

When a team of doctors or ethicists talk to patient to try to determine if they actually do have the capacity to give informed consent to medical treatment or research

what are the criteria in which the pt./subject is generally considered to have capacity?

• they can communicate a choice regarding tx. and their participation in the research/tx. process

  • they understand they can refuse the tx/research

• they demonstrate understanding of diagnosis/prognosis; nature of recommended care; alternatives; risks/benefits/consequences

• their decisions is not the result of delusions

• the pt. uses logical reasoning in making a decision

what are some of the greatest challenges that pt.s that lack capacity raise?

• pt.s lacking capacity pose some of the greatest challenges, raise some of the biggest conflicts:

• what is best for them medically v. what is most respectful of them, their past wishes, their families’ wishes

  • i.e. The child of Jehovah’s Witness needs a blood transfusion, but this is impermissible in the religion. What should be done?

    • Go through with the blood transfusion b/c the child is still a MINOR -> we apply the best medical procedure/interest to the child (what’s most beneficent) since they haven’t had a chance to endorse heir religious values yet

    • acting on beneficence keeps the most doors open for the child

what are the many ways one can lack capacity?

• Young child or infant

• Neurologically damaged adult

• Neurologically damaged infant

• Elderly person w/ dementia

  • Had past competence, wishes, and wills

• Adult w/ schizophrenia

  • Under the grips of psychosis, delusions, hallucinations, etc.; and go in and out competent consciousness (lucid) and incompetent consciousness (episode)

• What matters or is in the best interest of each of these people may vary widely

• Note: children of older age can “assent” rather than consent

  • Try to get assent when interacting w/ pt.s who lack competence

What to do when a pt. is deemed incompetent

use the hierarchy of decision-making standards (in bioethics)

1. check if the person has an advanced directive or expressed desires about tx. and consult this to figure out the pt.’s desires

   1. These should be respected (but this is not always obeyed by the physician, this is what is said to be a respected decision according to an ethicist)

      • In a situation which two parties w/ roughly equal authority over an incompetent pt. disagree with the next best procedure for the pt.; hospitals will direct this issue to the court, and this becomes a court case

2. Substituted Judgment (next of kin)

   1. Next of kin —that was appointed by the pt before they went unconscious— (i.e. spouse, adult children, adult siblings, parents, grandparents, nephew/niece (family members)) make the decision on what either what the kin wants or the one that the kin thinks that the pt would want most

   2. person who can consent to tx. (for incompetent ind.)

      1. adult pt w/ capacity

      2. surogate decision maker (kinda rare, go down to 6 pretty quick after 1)

      3. agent (deferred to a power of attorney)

      4. conservator (3rd party appointed by the court)

      5. court appointed surrogate decision maker

      6. closest available relative

      7. interdisciplinary team (ppl employing the best interest standard)

3. use the best-interests standards, for those who have never had ability to make judgments

   1. decide based on what’s medically best for the person; taking into account the prognosis and quality of life