Universal Principles of Biomedical Ethics

AUTONOMY

  From Greek word autos (self) and nomos (governance).

Self-determination  1.

2.

3.

3 Elements The ability to decide.

The power to act on your decisions A respect for the individual autonomy of others.

AUTONOMY

 Informed consent > elements of disclosure > understanding > voluntariness > competence > permission giving

AUTONOMY

 Legal Exceptions to the Rules of Informed Consent < Therapeutic Privilege>  Cases of emergency  Incompetence  Waiver  Implied consent

AUTONOMY

    Therapeutic Privilege Benevolent Deception Paternalism Fiduciary Relationship

VERACITY

   Binds the health practitioner and the patient in an association of truth. When faced with situations in which lying seems a rational solution, other alternatives must be sought.

The harm to patient autonomy and the potential loss of practitioner credibility makes lying to patients a practice that in almost all cases should be avoided.

VERACITY

 1.

2.

3.

4.

Justification of Paternalism The lie benefits the person lied to: that is, the lie prevents more evil than it causes for that particular person.

It must be possible to describe the greater good that occurs.

The individual should want to be lied to. If the evil avoided by the lie is greater than the evil caused by it, a person would be irrational not to want to be lied to.

Assuming equal circumstances, we would always be willing to allow the violation of veracity.

BENEFICENCE

  Term that suggest acts of mercy and charity expanded to include any action that benefits another.

The obligation to help imposes on healthcare practitioners the duty to promote the health and welfare of the patients above other consideration, while attending and honoring the patient’s personal autonomy.

BENEFICENCE

  Is the restoration of life that appears to have no value to the individual, beneficence?

Are the staggering fiscal and emotional costs justifiable?

* With modern medicine, in which technology often overwhelms resources, it has become necessary to use cost-benefit ratio analysis to determine where beneficence ends and maleficence begins.

NONMALEFICENCE

 Dinstinction between Nonmaleficence and Beneficence offered by T. Beauchamp and J. Childress.

Nonmaleficence

1. One ought not to inflict evil or harm .

Beneficence

1. One ought to prevent evil or harm.

2. One ought to remove evil or harm.

3. One ought to do or promote good.

CONFIDENTIALITY

 A patient’s basic right to expect the information he gives a health care practitioner to be held undisclosed.

 An important aspect of the trust that patient’s place in health care professionals.

CONFIDENTIALITY

 Instances in which Confidentiality is Overridden < Secrets: On the Ethics of Concealment and Revelation by Sissela Bok>:  Child abuse  Contagious disease  STD’s  Wounds caused by guns and knives  Cases in which identifiable third parties would be placed at risk by failure to disclose information.

CONFIDENTIALITY

 Harm Principle - a principle that limits the personal protective privilege of confidentiality.

- requires the hcp to refrain from acts of omissions that would foreseeably result in harm of others, especially in cases in which the individuals are particularly vulnerable to the risk.

Role Fidelity

   Self-regulation is one of the key elements of profession. Professional code of ethics are important documents in the process of self-regulation.

Under no circumstances may the practitioner place his financial interests above the welfare of his patients.

The primary objective of the hcp is to render service to humanity. Reward or financial gain is a subordinate consideration.

Role Fidelity

  All clinicians must understand and remain within the constraints of their professional practice act.

Gatekeeping within role duty and fidelity requires the individual practitioners be responsible not only for their standard of practice but works to protect the community, patients and our specialties from abuse of other practitioners.