Study Notes on Foundations of Bioethics and Major Moral Principles

Making moral decisions is difficult and often involves feelings of uncertainty and self-doubt.
There are no mechanical processes or algorithms for making ethical decisions; individuals must navigate moral doubt independently.
When time allows, one can apply general ethical theories to find answers to moral questions, but this is rare in everyday situations.
An approach known as principlism is used, where freestanding moral principles derived from various theories can guide ethical decision-making.
- Example Principle: "Avoid causing needless harm."
The section will illustrate five key moral principles relevant to medical care and research, each with limitations.
- These principles may conflict and do not provide a coherent moral theory for conflict resolution.
All discussed theories would endorse the legitimacy of these principles, even if they weigh them differently.
These principles serve as guidelines rather than automatic rules, ensuring decisions stem from genuine moral inquiry, reducing arbitrary decisions, and evaluating actions based on reasoned standards.

Often stated as "Above all, do no harm."
- This captures the duty of those responsible for patient care not to harm patients through carelessness, malice, or ignorance.
Nonmaleficence can be defined as the obligation to act in ways that do not cause needless harm to others.
Positive formulation: Duty to avoid maleficence (harm or injury).
Violations of this principle occur when:
- Someone intentionally harms another, such as a surgeon deliberately causing injury.
- Someone causes harm through negligence, like a nurse administering the wrong medication.
The duty does not require achieving perfection in medicine due to unpredictable treatment outcomes.
Physicians must uphold reasonable standards of professional responsibility that define due care.
Standards include: caution, diligence, and possessing adequate knowledge and skills.
- Failure to meet these standards may lead to charges of moral and legal maleficence.
Society enforces standards through education, licensing, and credentialing to ensure a minimum level of knowledge and care.
The evolution of medical practices illustrates changing standards of due care, affecting perceptions of responsibility in practice.
Example: A general practitioner performing complex surgery without proper training may be criticized despite no actual harm occurring, as standards have evolved.
The principle accepts necessary risks in treatment, guided by informed consent and justified necessity, such as in life-threatening situations.

Derived from the Hippocratic corpuses: "To help or at least do no harm."
The principle of beneficence can be described as acting in ways that promote others' welfare.
- This duty is inherent in the physician-patient relationship; a physician should promote the patient’s welfare.
There is debate on whether promoting welfare is a moral duty or an expectation. Beneficence implies inherent duties for health professionals.
In vital situations, a physician must prioritize the patient's good, even if it leads to a potential role conflict.
Physicians are expected to make reasonable sacrifices for patients and assume full responsibility during treatment.
- An example includes a physician canceling personal plans to address a medical emergency.
Implicit standards of beneficence exist; appropriate treatment should reflect the best interests of patients
Society's broader obligation to beneficence is seen in public health initiatives; historical public health advancements show social responsibilities toward citizen health.
Social beneficence faces limitations due to finite resources, necessitating societal choices about healthcare distribution.
- Example: The debate on whether to ensure all citizens adequate medical care vs. minimal catastrophic coverage.

Formulated as acting to bring about the greatest benefit and least harm.
This principle, while linked with utilitarianism, serves as one moral guideline among others, operating with prima facie duties, requiring careful consideration of rights.
In social contexts, utility helps navigate healthcare distribution among competing societal needs.
- Example: Balancing funding for health care against education and housing needs.
Within medical ethics, this principle guides decision-making about diagnosis and treatment, weighing proposed interventions against risk versus benefit ratios.

The concept involves ensuring just treatment regarding social goods distribution, including healthcare.
Justice encompasses two aspects:
- Noncomparative justice: Ensuring rights are recognized and protected.
- Comparative justice: Concerned with laws and the distribution of burdens and benefits, particularly relevant to healthcare.
Distribution questions arise: Are all entitled to healthcare, regardless of payment ability?
Philosophical theories seek to justify social goods distribution, compelling rational bases for distinguishing between situations.
Formal principle of justice: Similar cases should receive similar treatment, grounded in fairness.
Substantive principles of distribution may include:
- Equality: All benefits and burdens distributed equally, ensures similar treatment.
- Need: The principle where more should be given to those with greater needs.
- Contribution: Proportional distribution based on one's productive labor.
- Effort: Individuals should receive benefits corresponding to their effort.

Defined as the right of rational individuals to make self-determining choices.
- Autonomy respects the inherent worth of persons, avoiding manipulation by others.
Various aspects influence autonomy:
- Actions: Coercion limits autonomy whether through force or confined regulations, impacting decision-making.
- Options: Genuine choices must exist, unencumbered by socioeconomic constraints.
- Decision-Making: Informedness is essential for autonomy.
Physicians must ensure informed consent in treatment choices, respecting patient autonomy while avoiding paternalism.
Restrictions on autonomy are not absolute; compelling justifications exist, typically relying on principles like harm.
- Harm Principle: Auto-restrictions justified to prevent harm to others or oneself.
- Paternalism: Justifies restricting autonomy for self-benefit or to avert self-harm.
- Legal Moralism: Justifies legal limitations on actions considered morally wrong.

Each principle plays a vital role in evaluating medical decisions, shaping healthcare policies, and establishing moral guidelines for practitioners.
Understanding these principles informs both personal ideologies and legislative frameworks, ensuring ethical structures in medicine.
The application of these principles enhances moral deliberations, aiming to improve patient care and policy efficacy.