The principles of bioethics

Cristina Gavrilovici, MD, MA, PhD

cristina_gavrilovici@yahoo.com
 1. Respect for Autonomy

2. Beneficence

3. Non maleficence

4. Justice
 1. Respect for Autonomy

• Did you make any difficult choices recently?

• If you visit a doctor, do you make treatment

decision on your own or in discussion with other
family members and the doctor?

• What are the limits to personal choice? (if any)

 1. Respect for Autonomy

• rational agents are involved in making informed and

voluntary decisions.

• in health care decisions, our respect for the

autonomy of the patient would mean that the patient
has the capacity to act intentionally, with
understanding, and without controlling influences

– this principle is the basis for the practice of "informed

consent" in the physician/patient transaction regarding
health care.
 Respect for autonomy

autonomy = freedom + rationality

Rights Duties
 Respect for autonomy

• In the US: Engelhard: autonomy = permission

•European concept of autonomy: shaped by a

Kantian framework: autonomy is built on moral
responsibility, commitment and concern for
other human being
 Respect for autonomy

Is autonomy functioning as a leading

moral principle in all societies?

4 models of patient-physician relationship:

• paternalistic
• informative
• interpretative
• deliberative
 What are the characteristics
of a society in which respect
for autonomy can override the
other principles?

1. Patients would want to take decisions

2. Patients would want to receive informations
3. Physicians would be able and willing to offer the
information
4. Patients would need to understand the information
and remember it
5. Patients would appropiately debate the medical issues
 Respect for dignity

Dignity concerns the aspect of human life in which

autonomy is not enough to understand:

• the emotions of the beginning and at the end of

life
• the human body parts commercial
 Respect for integrity

This liberal concept states that no one is entitled

to use one’s body against one’s will: all humans are
owner of the body (?).

If yes, are they entitled to sell parts of their

body if they wish to do so?
 Respect for vulnerability

• Social constructed term

• To what extent a vulnerable person can

freely and autonomously exercise his/her
rights?
 2. The Principle of
Nonmaleficence
• This principles requires of us that we not
intentionally harm or injury the patient,
either through acts of commission or
omission.

• we consider it “negligence” if one imposes a

careless or unreasonable risk of harm upon
another. In a professional model of care one may
be morally and legally blameworthy if one fails to
meet the standards of due care.
 2. The Principle of
Nonmaleficence
The legal criteria for determining negligence are
as follows:

1. the professional must have a duty to the

affected party
2. the professional must breach that duty
3. the affected party must experience a harm;
and
4. the harm must be caused by the breach of
duty.
 3. The Principle of
Beneficence

• Choose one example of a

technological advancement and
identify the benefits and risks of
this new technology!
 3. The Principle of
Beneficence

• The ordinary meaning of this

principle is the duty of health care
providers to be of a benefit to the
patient, as well as to take positive
steps to prevent and to remove
harm from the patient.
 3. The Principle of
Beneficence

• nonmaleficence is a constant duty, that

is, one ought never to harm another
individual.

• beneficence is a limited duty.

 4. The Principle of
Justice

• “All human beings have equal rights”.

Do you agree or disagree with this

statement?
 4. The Principle of
Justice
• Justice in health care is usually defined as
a form of fairness.

• Distributive justice: some goods and

services are in short supply, there is not
enough to go around, thus some fair means
of allocating scarce resources must be
determined.
 4. The Principle of
Justice
Our society uses a variety of factors as a
criteria for distributive justice, including the
following:
1. to each person an equal share
2. to each person according to need
3. to each person according to effort
4. to each person according to contribution
5. to each person according to merit
6. to each person according to free-market
exchanges
What can you do to make the
situation in the world better
for others? Now and in the
future?