Bioethics & Health Law:

Basic Moral
Principles
Amalia M. Darmawan

Definition

1.
2.
3.

Bioethics 1)
The study of ethical issues and decisionmaking associated with the use of living
organisms
Moral 1)
concerned with the judgment of the goodness
& badness of human actions & character
the lesson or principle contained in or taught
by a fable, story, or event
rules or habits of conduct, with reference to
standards of right & wrong

Objective

Show how ethical theory can illuminate problems

in health care and help overcome limitations of
past formulation of ethical responsibility

Unreasonable to expect
any theory to overcome all limitations of time
& place, & reach a universally acceptable
perspective

Four clusters of principles

Respect for autonomy
respecting the decisionmaking capacities
2. Nonmaleficence
avoiding the causation of harm
3. Beneficence
providing & balancing benefits against risks & costs
4. Justice
distributing benefits, risks, & costs fairly
1.

Autonomy

self-rule (Greek) right of individuals to make

choices
See that people are different

Personal choices
Respecting people as equal persons with their
own set of values
a duty to let people make their own choices
corresponding responsibilities of individuals
towards society

Beneficence
Beneficence attempt to do good
Balance doing good >< risk of doing harm
Tools: - risk assessment
- cost-benefit analysis

Cases where beneficence >< autonomy?

Nonmaleficence

Precise outcome not always certain!

Uncertainty risk of failure?
chance of success?
Try to minimize or avoid doing harm
Failure to attempt to do good

Form of doing harm

Examples of risky technology?

Justice

Autonomy is limited by balancing desires with

respect for the autonomy of other individuals
Justice = fairness = equity
equality in access to health care
Problems:
- Scarce resources/treatments for patients
- Socioeconomic situation of patient & families
- Healthcare system & healthcare budget

Conflict / Dilemmas

Refusal for treatment

Scarce resources
New medical technology
Socioeconomic situation
Withholding & withdrawing treatment

Other specific issues:

Responsibility to other health care providers
Religion-social related issues
Alternative medicine
Research ethics

Conclusion
Bioethics is not about thinking that we can
always find one correct solution to ethical
problems. There can be different choices
made after ethical reflection
Fundamental ethical principles can aid
decision making
Bioethics is learning how to balance
different benefits, risks and duties

References
1.
2.

3.
4.
5.

Macer, D.R.J. (editor). A Cross-Cultural Introduction to

Bioethics. Bangkok: Eubios Ethics Institute, 2006.
Beauchamp, T.L., Childress J.F. Principles of
Biomedical Ethics, 4th ed. New York: Oxford University
Press, 1994.
Lo, B. Resolving Ethical Dilemmas. Baltimore: Williams
& Wilkins, 1995.
Jonsen A.R., Siegler, M., Winslade, W.J. Clinical Ethics,
5th ed. New York: McGraw-Hill, 2002.
WHO Regional Office for South-East Asia. Health Ethics
Teaching Guidelines for the SEAR Countries. New
Delhi, 2002.