Ethical Studies & Principals Part 3: Biomedical Studies

Framework for Ethical Thinking in Health Care

Overview of Ethical Frameworks

  • Many health professionals are trained within a specific ethical framework.

  • Limitations of this framework, especially in public health contexts.

  • Focus on the work of Beecham and Childress, prominent twentieth-century American philosophers.

Contributions of Beecham and Childress

  • Beecham: Key participant in drafting the Belmont Report, which followed the controversial Tuskegee Syphilis Study.

    • The Belmont Report is crucial in understanding ethical principles in biomedical research and public health.

  • Childress: Served on national ethics committees focused on areas like organ donation, gene therapy, and clinical trials at the National Institutes of Health (NIH).

    • Both philosophers addressed questions that arose due to advances in healthcare technology.

Ethical Dilemmas in Health Care

  • Historical context:

    • Prior to 1970s: Death was often defined unequivocally; a stopped heart meant death.

    • Emergence of Coronary Care Units in the 1960s and 1970s, now known as Intensive Care Units (ICUs).

    • Described as "halls of miracles" by instructors—ventilators sustain life until hearts heal.

  • New ethical challenges emerged:

    • Some patients do not improve and remain alive on ventilators, raising complex dilemmas:

    • Should we discontinue ventilation (described as "pulling the plug")?

    • Does turning off the ventilator equate to actively causing the patient’s death?

    • Ethical implications of resource allocation for both healthcare resources and the family's emotional/financial capital.

  • Publication of Principles of Biomedical Ethics (1978) by Beecham and Childress in response to these ethical dilemmas.

Four Ethical Principles According to Beecham and Childress

  1. Beneficence

    • Definition: The ethical obligation to do good; the Latin root "bene" means good.

      • Related words include: benefit, beneficial, bueno (Spanish), bon (French).

    • Moral responsibility: Engage in actions that promote wellbeing.

  2. Non-Maleficence

    • Definition: The ethical obligation to not cause harm; "male" implies bad or evil.

      • Related terms: malware (harmful software), maleficent (the Disney villain).

    • Common interpretation: The Hippocratic Oath's charge to "do no harm" as a foundational principle.

    • Complications arise when actions produce both harm and benefit:

      • Example: Pain inflicted during medical procedures (like IVs or injections) is justified by the greater good they serve (ultimately protecting health).

      • Principle of Double Effect: An important concept relating to this dilemma, where positive outcomes justify the temporary harm caused.

      • Personal anecdote illustrating this principle: Vaccination experience with the instructor's youngest son, where immediate pain was outweighed by long-term health benefits.

  3. Autonomy

    • Definition: The right of individuals to self-governance and make informed personal decisions regarding their health.

      • Root from auto, meaning self.

    • Critical to informed consent: Individuals must understand the consequences and risks before making health decisions.

    • Focus in biomedical ethics has been individual autonomy; however, may differ in public health contexts where community well-being must be balanced (e.g., smoking bans).

  4. Justice

    • Definition: Ethical principle focused on the fair distribution of healthcare resources and social equity.

      • Recognizes systemic inequities in access to health resources; advocates for social justice in public health.

      • Aims to promote equity in health outcomes across diverse demographic groups.

Additional Principles

  1. Fidelity

    • Definition: Faithfulness and promise-keeping; ensuring trust between healthcare professionals and the public.

      • Indicates an ethical responsibility to uphold commitments and be cautious about what promises are made.

  2. Veracity

    • Definition: Commitment to truth-telling.

      • Although intuitively right, truth-telling can require careful timing, consideration of audience, and context.

      • Possible ethical dilemma: At times, especially in research, delaying full disclosure may be necessary for wider public health goals.

      • Necessitates strong justification if steps are taken to withhold or delay truth.

Limitations of Principles of Biomedical Ethics

  • Originally designed for individual practitioners and patients; thus, it may not fully address public health ethics.

  • Ethical committees may hold differing priorities compared to families or communities.

  • Intelligence and analytical skills of decision-makers do not always correlate with ethical character, risking ethical oversights.

  • The framework may emphasize rationality while neglecting the human elements involved in ethical dilemmas.

  • Further exploration of additional ethical theories will be necessary to address these shortcomings.