bioethical principles in health care

Daenna Eliza s. Borbon BSN-2

Bioethical Principles in Health Care

Chapter 2 Outline

i.) The principle of Autonomy One of the most important principles in bioethical sphere, particularly in

medical ethics, is the concept of autonomy. A lot of biomedical discussions, in one way or the other, to a large extent, presumes the value and significance of individual autonomy.

Etymologically, the term autonomy comes from the Greek word- autos (self) and nomos-governance. Thus autonomy is

generally defined as” self- governance or self-determination. In the medical domain, the patient is said to have acted autonomously

when he or she, and not others makes the decision regarding the way his or her treatment goes” free deceit, duress, constraint or coercion.

In the context of health care the principle of autonomy specifically applies to respect for the patients autonomy.

A person’s autonomy -is his or her independence, self-reliance and self-contained ability to decide.

The medical professionals can do in accordance with the principle in dealing with their patients:

1.) Obtaining informed consent for treatment2.) Facilitating patient choice regarding treatment options3.) Allowing the patient to refuse treatment4.) Disclosure by the provider of personal medical information,

diagnoses and treatment options to the involved patient5.) Maintaining confidentiality

The basic right to self-determination is said to put a clear boundary with regards to what physicians, nurses and other health care professionals can justifiably do to patients under their care. As a matter of fact this right becomes so important that a lot of medical practitioners have been sued in court, rightly or wrongly for having allegedly violated this fundamental patient’s right.

Liberty limiting Principles

1.) A person’s liberty is justifiably restricted to prevent that person from harming others(the harm principle)

2.) A person’s liberty is justifiably restricted to prevent the person from offending others( the offense principle)


3.) A person’s liberty is justifiably restricted to prevent that person from harming him or herself(The principle of paternalism)

4.) A person’s liberty is justifiably restricted to benefit that person(principle of extreme paternalism)

5.) A person’s liberty is justifiably restricted to prevent that person from acting immorally (The principle of legal moralism).

6.) A person’s liberty is justifiably restricted to benefit others (the social welfare principle.)

Thus, the principle of autonomy in the context of medical care applies only to those persons who are still very much capable of self-directed and independent judgment. It is not therefore absolute and unqualified.It is worth noting that respect for autonomy of patients has given rise to many other rights afforded to the patient- among them the right to confidentiality and privacy, the right to informed consent and the right to competent medical care.

ii.) The principle of Informed ConsentFrom the basic principle of autonomy comes the related and equally significant concept of informed consent, which generally contains the elements of disclosure, understanding, voluntariness, competence and permission giving.Though relatively recent in medical practice as a prerequisite concerning doctor patient relationship it is now widely accepted that competent adult patients have a moral and legal right not to be subjected to medical interventions without their informed and voluntary consent.

Informations that a medical practitioner must provide to the patient(In a language that he or she can understand)

1.) A description of the recommended treatment or procedures2.) A description of the risks and benefits of the recommended procedure, with

special emphasis on risks of death or serious bodily disability3.) A description of the alternatives including other treatments or procedure and the

risks and benefits of these alternatives4.) The likely results if no treatment is administered 5.) The probability of success, and what the physician means by success6.) The major problems anticipated in recuperation and time period during which the

patient will not be able to resume his or her normal activities7.) Any other information generally provided to patients in this situation by other

qualified physicians


And while these consent measures have mainly and particularly been designed to protect the autonomy of patients and subjects, they also serve other significant purposes.

Important Functions of Informed Consent1.) The promotion of individual autonomy2.) The protection of patients and subjects3.) The avoidance of fraud and duress4.) The encouragement of self-scrutiny by medical professionals5.) The promotion of rational decisions6.) The involvement of the public(in promoting autonomy as a general social

value in controlling biomedical research)

While it is true that not all patients will take the information necessary for informed consent seriously as they should, this does not excuse, in any way, the health care professional concerned to neglect this very crucial principle in the physician-patient relationship

iii.) The Principle of BeneficenceThe word “beneficence comes from the Latin bene, which means “good”. Generally, beneficence means taking action to promote the well-being of others. Practically, all medical practitioners consider beneficence as the most basic biomedical principle.In the domain of health care, The principle of beneficence is one that requires (health professionals) to act in ways that benefit patients. The principle of beneficence is the one that imposes on the practitioner a duty to seek the good of the patient in all circumstances..There is no question that any health care practitioner worthy of the name, is obligated to act beneficently to his patient. By virtue of the nature of their calling,”beneficient acts are morally and legally demanded by the role of health care professionals.


According to moral Philosopher William Frankena The principle of beneficence consists of

Four important elements.:

1.) One ought to do or promote good2.) One ought to prevent evil or harm3.) One ought to remove evil or harm

4.) One ought not to inflict evil or harm

It is firmly held that “the failure of practitioners to increase the good of others when they are in a position to do so- and not simply to avoid harm- is morally and professionally wrong. In fact the primary driving force of biomedical research and experimentation is the production of positive benefits for society in general.

Harm here in medical setting has to be within the context of making the condition of the patient better. “Even giving an injection is potentiality harmful. In order to prevent harm from treatments and care, it is therefore important that policies and guidelines concerning procedures are followed.

iv.) The Principle Of NonmaleficenceClosely akin to the principle of beneficence is the principle of nonmaleficence. While the former admonishes health care professionals to do good to their clients, the latter requires them “ to act in such manner as to avoid causing harm to patients”. While the principle of beneficence” involved positive action toward preventing or removing harm and promoting the good… nonmaleficence. Admonishes to refrain from inflicting harm.The principle of nonmaleficence, as applied to health care, covers acts that deliberately harm, injure, risk of harm as well as harm that occurs during the course of doing beneficial acts on the part of the patients.This particular principle is expresses in the process of delivering health care, cannot bring about good for the patient, he or she is bound by duty to at least avoid any harm to the patient under his or her care.There are of course situations wherein the harm and benefit are of equal value and this presents a real dilemma on the part of the health care professional. This is where the field of ethics as a critical inquiry, with its various ethical theories can be of help.`


v.) The Principle of PaternalismPaternalism is widely defined as the “interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good happiness, needs, interests or values of the person being concerned. In the sphere of medical care, paternalism as a concept relates to health professionals who restrict others autonomy, usually to protect that person from perceived or anticipated harm.Usually paternalistic act is performed when a patient is judged to be incompetent or to have diminished decision making capacity.As an act paternalism is performed when “health care professionals make choices for patients in the best interest of the patient or for the patient’s own good.It is always viewed that paternalism runs in conflict with autonomy. In a way paternalism is the “intentional limitation of the autonomy of one person by another, where the person who limits autonomy appeals exclusively to grounds’ of benefit to the other person .In a sense, paternalism always involves some form of interference with refusal to conform to another person’s preference regarding his own good. Hence it normally includes some form of force and coercion on the one hand deception lying withholding or nondisclosure of information on the patient on the otherIn particular sense paternalism necessarily places a limit to autonomy on the part of the patient.

vi.) The principle Of JusticeSimply speaking justice has something to do with “what is fair or what is deserved”. An injustice takes place “when some benefit or good to which a certain individual is entitled is denied without good reason or when some burden is imposed unduly.Justice is the ethical principle that relates to fair equitable and appropriate treatment in light of what is due or owed to persons, recognizing that giving to some will deny receipt to others who might otherwise have received the things. Hence justice is giving one what is due to him or her in relation to others with practically the same need.In the context of health care, justice would mean giving due care to each and every patient. This further means that if a particular medical client needs care, the health care professional involved does not have the right to refuse health care on him or her.


Helpful guide in responding to the problem of justice1.)To each person equally

2.)To each person according to individual need

3.)To each person according to merit

4.)To each person according To social contribution

5.)To each person according To the person’s rights

6.)To each person according to individual effort

7.)To each person according to the greatest good for the greatest number.

Nonetheless, some bioethicist has argues upon the following standards that have to be applied or at least considered when allocation and distribution of scarce medical resources are made:1.) Distribute according to market; that is , to those who can afford to pay2.) Distribute according to social merit3.) Distribute according to medical need4.) Distribute according to age5.) Distribute according to queuing, on first-come, first served basis6.) Distribute according to random selection

vii.) The Principle of Veracity(truth telling)The notion of veracity has something to do with the practice of telling the truth. The duty to tell the truth and nothing but the truth is categorical imperative that is central and prominent in the ethical thought of the great German philosopher Immanuel Kant. Telling the truth is fundamental to being ethical and moral.It is commonly agreed that yes, indeed, we all have the moral obligation to be truthful in our dealing with others.Truth telling is considered a very important value among patients that is expressed and highlighted in the statement on a patient’s bill of rights. The second sentence of this particular document reads: “patients have the right to obtain complete information concerning diagnosis, treatment and prognosis in terms they can be reasonably expected to understand.It is commonly held in medical ethics that the duty of veracity is part and parcel of the health care provider and patient relationship. In the domain of health care, respect for the patient is an integral part of the principle of autonomy.In brief, the practice of health care is best served in a relationship founded on trust in which practitioner are both bound to the truth.


viii.) The Principle Of ConfidentialityA close related principle to veracity is the principle of confidentiality. In the medical context, confidentiality is “the ethical principle that requires nondisclosure of private or secret information with which one is entrusted. It is this principle that binds the practitioner to hold in strict confidence that information he or she obtained and learned about regarding the patient in the course of medical treatment.This particular medical ethical principle finds its support in various codes of ethics in medicine and nursing throughout recorded history.The first function of confidentiality in health care relates to the medical professional’s recognitions of the autonomous patient’s sense of individuality and autonomy as well as his or her sense of privacy.Confidentiality is said to be supremely important when disclosure of very sensitive and personal information will have negative effect on the part of the patient.First-Patient’s most personal physical and psychological secrets are kept confidential in order to decrease a sense of shame and vulnerability.Secondly-Confidentiality is important in improving patient’s health care.Notwithstanding, confidentiality is an important value without which, the entire health care profession would be less noble and humane.

bioethical principles in health care

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