Universal Principles of
Biomedical Ethics
AUTONOMY
 From Greek word autos (self) and nomos
(governance).
 Self-determination
 3 Elements
The ability to decide.
2. The power to act on your decisions
3. A respect for the individual autonomy of others.
1.
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
 Justification of Paternalism
The lie benefits the person lied to: that is, the lie
prevents more evil than it causes for that
particular person.
2. It must be possible to describe the greater good
that occurs.
3. 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.
4. Assuming equal circumstances, we would always
be willing to allow the violation of veracity.
1.
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.