Basic Ethical Principles 1(2)

8/4/2019 Basic Ethical Principles 1(2)

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BASIC ETHICAL PRINCIPLES

Basic fundamental, essential, important, that which forms

the foundation

Ethics practical science of the morality of human conduct

Principle a generally accepted rule or standard that guide

BASIC ETHICAL PRINCIPLES essential rules that guide human

persons in their behavior and conduct.

PRINCIPLES OF STEWARDSHIP

Stewardship involves managing, taking charge or

caring for anothers property.

Ownership involves possession or belonging to

1. THE PRINCIPLE OF STEWARDSHIP MAINTAINS / CLAIMS

THAT:

a. Human life and nature, our bodies and the earth,

with all its natural resources that sustain life,

belong to God. Therefore, NO individual owns his

body or life, nor is he/she the master of his/her

own body.

b. God, the owner, assigned us to be stewards or

caretakers of our own bodies, life, health, the

earth and everything in it.

As faithful stewards, we, therefore, have the

responsibility to:

b.1. ourselves such as:


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Respect, use our originality and creativity

to cultivate our bodies and everything on

earth

Take good care or ourselves, to maintain a

sound in mind and body and safeguard our

dignity

to improve our bodies, know and respect our

limits as we improve ourselves

to develop medical technologies that

prevent and remedy the defects but we must

do so with the greatest respect for what we

already are as human beings

to use our greatest natural gift of

intelligence and freedom in a COCREATIVE

manner, not a reckless wasting of the gift

not to contradict human nature

Ways by which we care for our own health (Good Habits):

b.2. to take care of the health of our neighbors and

the environment by:

help conserve our ecological system not

polluting the air, land and water

recycling / reusing natures raw materials

and energy supplies

b.3. to help liberate others from poverty, disease,oppression and exploitation

2. PRINCIPLE OF TOTALITY

TOTALITY refers to the whole or wholeness of an

individual, which includes the physical, mental /


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psychological, spiritual, social and emotional

aspects. It also includes wholeness of a community

(SPECE).

The principle of Totality maintains that:

a. Human health is not merely a matter of organs but

of capacity to function humanely and on the basis

of wholeness.

b. Every person must develop, use, care for and

preserve all his/her parts and functions for the

own sake of each part and function as well as for

the good of the whole.c. Every person must preserve life and the integrity

of our bodies.

d. The basic capacities, which define personhood

(organs, functions, all other aspects), however,

are sacrificed ONLY when there is a need to

preserve life.

e. If a body part or lower function harms the whole,

this part of lower function maybe sacrificed for

the good or better function of the whole.

Any particular human functional capacity can be

diminished when necessary for the good of the whole

person as in the case of over production of thyroid

hormones. Medications are given to decrease or

diminish the function of the thyroid gland.

A secondary function can be sacrificed for a more

basic one as in the case of


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f. NOT ALLOWED UNDER THE PRINCIPLE OF TOTALITY is the

donation of a healthy organ if it weakens the

health of the donor.

3. PRINCIPLE OF DOUBLE EFFECT. This principle states or

claims that:

a. Double effect means that an act is foreseen to

have both good and bad effects.

b. There are certain conditions in which some evil

or bad effects, voluntary in cause, maybe

permitted to occur.

Four conditions that must be met so that such an

act with bad effects may be permitted:

(1) The direct-freely-chosen effect of the act must

be morally good while the other indirect-not

freely-chosen effect maybe physically harmful.

The harm must never be intended but merely

tolerated as casually connected with the

good intended, or

There must be sufficient and proportionate

reason for allowing the evil effect to occur

while performing the action.

The directly intended object of the act must

not be intrinsically contradictory to ones

fundamental commitment to God and neighbor,

including the self.


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(2) The action itself must be good or at least

morally neutral (not extrinsically nor

intrinsically evil act).

The action directly intended must be good in

itself or at least, morally indifferent.

(3) The foreseen beneficial effect must be equal to

or greater than the foreseen harmful effect.

the good must outweigh the harm

the intension of the agent must be to

achieve the beneficial effect and as far as

possible to avoid the harmful effect (that

is, must only indirectly intend the harm)

(4) The beneficial effect must follow from the

action at least as immediately as the harmful

effect. The good effect must not be produced by

the bad effect.

the good must not follow as a consequence of

the secondary harmful effect.

The good effect must follow from the action

at least a immediately as the harmful

effect; or the evil effect may follow from

the good effect, but not the good effect to

follow from the evil act.

4. PRINCIPLE OF LEGITIMATE COOPERATION

COOPERATION means participation of one agent with

another agent to produce a particular or joint effect.


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Types of cooperation:

4.1. According to the voluntariness of the secondary

agent to cooperate:

a. Formal when the secondary agent willingly

participates through agreeing, advertising,

counseling, promoting or condoning (ignoring,

overlooking, excusing, justifying) the act of a

primary agent.

b. Material when the secondary agent does not

willingly participate in the act of the primary agent.

4.2. According to the intention/purpose of the secondary

agent in cooperating:

a. Immediate when the action of the secondary agent

is inherently bound to the performance of the evil

action.

b. Mediate when the action of the secondary agent is

not inherently bound to the performance of the act.

In order to carry out our responsibilities, we need to

cooperate with others. In cooperating with others, we

frequently foresee that this may involve us in conducts

that are maybe objectively wrong but perceived by the

main doer as not evil. When should we cooperate or refuse

to cooperate?

The principle of cooperation states that:

a. We may participate in a material mediate

cooperation. This means that cooperation is merely

material or that the cooperation is with the good that is


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being done and only indirectly with evil, which we would

prevent if possible.

Reason why material mediates cooperation. This

means that cooperation is permitted: To

prevent a greater harm from occurring.

b. Cooperation is even obligatory permissible if:

b.1. the refusal to cooperate would result in a

greater evil than if we cooperate

b.2. the cooperation is not immediate and is

more remote the greater the evil involved

b.3. a scandal is caused or a bad example is

given to others when cooperation is done

c. We must refuse to cooperate when:

c.1. the action of the primary agent is morally

wrong.

c.2. we would involve ourselves in formal

cooperation, that is, agreeing with,

advising, counseling, promoting or

condoning the objectively evil action of

another, because formal cooperation demands

that we directly intend the evil

action itself, which is morally

equivalent to doing it ourselves.

d. when the secondary agent does not willingly

participate but his action is indirectly bound to the


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performance of the evil action (material immediate

cooperation).

5. PRINCIPLE OF SOLIDARITY (COMMON GOOD, SUBSIDIARITY

AND FUNCTIONALISM) principle that conceives social

authority or leadership in the community as service

rather than domination.

SOLIDARITY means to be one with others

The principle of solidarity states or claims that

human communities exist only to promote and share thecommon good among all its members from each according

to ability, to each according to need in such a way

that:

a. Decision making rests vertically first with the

person, then with the lower social levels and

horizontally with functional social units.

b. The higher social units intervene only to supply

the lower units what they cannot achieve by

themselves, while at the same time,

working to make it easier in the future for lower

units and individuals to satisfy these

needs by their own efforts.

Explanation of this principle:

a. This principle enhances the principle and spells out

the importance of human dignity which requires that

various levels of responsibility be established within

the community meaning, various levels have their own

respective roles to play, like the individual, sub-


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group in the community and the bigger community

itself.

If this division of labor happens, the dignity of

every community member will be fully recognized and

actively promoted.

b. Because of the presence of various levels that share

the task, it is therefore important to keep

decision making as close as possible to those

persons concerned and affected in the community

( subsidiarity those affected in the vertical

organization; functionalism those affected

horizontally)

c. While those in authority must protect and promote

the common good.

Implications or importance of this principle of solidarity:

(1) In health care provision, it is most important for

health care providers to be in solidarity with the

patient when seeking always the latters best

interest.

(2) In the Philippines, this is most important when

dealing with the poor, the uneducated, the

disadvantaged and the marginalized, because they are

the ones least provided, but most in nee, with

adequate health care.

(3) The strong will help the poor.

(4) As role models, the health care providers must be in

solidarity with each other in order to develop

professional cooperation.


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UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS

Universal general or all-inclusive

It is from these principles that we derive the rules

found in our professional codes of ethics.

I. AUTONOMY / SELF-DETERMINATION

Definitions:

o From the Greek word autos (self) and nomos

governance self governance. A term synonymously

used with autonomy is self-determination.

o In health care it has come to mean a form ofpersonal liberty, where the individual is free to

choose and implement ones own decisions, free

from deceit (lie) or duress (constraints, threat,

pressure, force or coercion). (Edge & Jones,

1999,p41).

The Principle of Autonomy upholds that:

o Every individual has the right to exercise

autonomy which should not be constrained by

others such that:

Person X has the right to determine what will be

done to him.

Person Y has a duty NOT to constrain Xs

autonomous choices and actions.

o Because human beings have inner worth, dignity

with the greatest gift of intellect, they should

then be accepted as responsible for their own

actions and allowed to make decisions for

themselves.


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For autonomy to be possible / occur, three basic elements

must be present:

1. Ability to decide requires adequate information and

intellectual competence as basis for choosing and

decision making.

2. The power to act upon ones decisions the capability

and influence to enforce what one has decided upon.

3. Provision for a general respect for the individual

autonomy of others this is the one that affirms or

specifically identifies the concept of autonomy.

Importance/significance of autonomy in the health caresetting:

1. It enhances a persons worth, especially the patient.

2. It protects a person, the patient, from being used or

exploited by others.

3. It helps develop a mature therapeutic alliance

(partnership) between the health professional and the

patient.

4. It forms the basis for the steps and rules of informed

consent.

Actions considered as violations to the principle of

autonomy:

1. Actions performed that constrain a persons capacity

to make a decision.

2. Actions performed that constrain a persons capacity

to act according to his decision.

Responsibility of the health professional: The health

professional should help the patient make an autonomous

choice and act on it by:


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1. Providing the patient with the information necessary

to weigh risks and benefits.

2. Stating his or her own convictions and clearly

explaining the reason for his opinion.

3. Not exercising coercion, manipulation, undue

influence, or irrational persuasion.

II. PRINCIPLE OF INFORMED CONSENT a principle whose

rules have been derived from the principle of

autonomy.

Definition: In health care, informed consent is defined

as the willing and uncoerced acceptance of a medical or

health care intervention by a patient after adequate

disclosure by the health care professional of the nature

of the intervention, its benefits and expected risks and

alternatives available.

Steps or rules to be followed in informed consent:

1. Disclosure of information this is the strong moral

obligation of the health care professional to provide a

TRUTHFUL AND HONEST information base on which to weight

risks and benefits in the light of his or her own values

and goods, to deliberate and finally, to make rational

choices.

General standards as basis about about what information

should be disclosed:

a. professional practice standards based on the traditional

disclosure practices of the professional community what


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the practicing physicians would generally accept as

necessary information to disclosure.

b. reasonable person standard that is based on what a

hypothetical reasonable person would judge as pertinent to

the decision making process what a prudent person thinks

is necessary for him or her to make a rational decision.

c. subjective standard which is based on what a particular

patient needs to know.

In general, the necessary items to disclosure include thefollowing:

a. the patients current medical status including the

likely course if no treatment is provided.

b. contemplated procedure or medication

c. alternative available procedures or medication

d. anticipated risks and benefits of both

e. a statement offering the patient an opportunity to ask

further questions

f. in case of research, his right to withdraw anytime

g. a professional opinion about the alternatives.

2. Comprehension of information this is the

responsibility of the health care professional to help the

patient understand the information, instead of just giving

the information.

Ways by which the health care professional would help the

patient understand the information:


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a. Give clear and simple explanations, instead of giving

too technical or complicated terms.

b. Evaluate or get feedback to assess the patients

understanding.

c. Provide written or printed instructions that are adapted

to the ability of the patient to read and understand.

3. Voluntariness by virtue of the true information

provided by the health care provider and consequent

understanding by the patient, voluntariness would mean

that the patient can now exercise his/her free choice

to participate or agree to whatever the informationasks, without coercion and other forms of control or

influence.

Factors that may hamper the voluntariness of the patient:

a. Forces exerted on the patient presence of fraud,

deceit or overreaching by the health care professional

b. Threat to abandon a patient unless he follows orders

c. Patients personal resistance

4. Competence this is plainly the capacity of the

patient to decide about a recommended procedure or

about participation in a research at the time and in

the context of the circumstances and based on rational

reasons (risks or benefits) and in the light of the

persons values and goals. Whether the person chooses

to use or not to use the information he/she has

decided upon is not anymore a criterion of competence:

Responsibility of the health care professional in

relation to competence: The health care professional must

be cautious against too rapidly judging a patient as


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incompetent in decision making because of the effect of

illness, anxiety, pain and hospitalization.

5. Permission giving

Situations which are considered as non-violations of the

principles of autonomy and informed consent and where

therapeutic privilege is followed / allowed:

1. Situations or cases where a patient signs a waiver to

delegate the authority to others, usually the physician.

Physicians delegated prerogative authority of aphysician over his patient as an authority delegated to

him/her by the patient.

2. Competence to give consent in absent or reduced

(incompetence of the patient is present) and the procedure

is necessary to save the persons life. By reason of

paternalism (those who know best will decide) and using his

professional judgment, the health professional can decide

that the amount of benefit offered by the procedure to be

done outweighs the loss resulting from failure to respect

autonomy.

3. Competition of the respect for patients autonomy with

other moral principles or autonomy vs. non-malecficence.

This means that when there is danger that respecting a

persons autonomy may harm or impose unfair burden on

another or that the principles of autonomy are overruled by

the principle of malecficence.


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4. Implied or presumed consent/common procedures upon

admission/ surgery anesthesia

a. By merely entering the patient-physician relationship,

implied (tacit or presume) consent for the customary

diagnostic and therapeutic procedures in common use is

given; therefore, theres no need to ask permission from

the patient.

b. When consent in some general line of action has been

given.

5. Surrogate consent happens when someone other that the

patient decides in behalf of the patient. The surrogate isconsidered to be morally responsible for the patient.

Pre-requisites to the surrogate consent:

a. Surrogate consent must promote the patients welfare.

b. If the patient has expressed preferences in making the

decision (substituted judgment) to give consent.

If the patients preferences are unclear, the

surrogate must consider the best interest of the patient

using some more objective, socially acceptable values, such

as relief of suffering and preservation and restoration of

function.

c. For minor patients, the surrogate consents are usually

given by parents or guardians.

III. PRINCIPLE OF VERACITY

DEFINITION OF VERACITY: Veracity is the principle of truth

telling from both the patient and the health practitioner.


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All allied health and nursing specialists should be

committed to the truth. (Edge and Groves, 1999, pp 44).

IMPORTANCE OF VERACITY:

1. The patient must tell the truth in order that

appropriate health care can be provided.

2. The practitioner needs to disclose factual information

so that the patient will have a good/sound basis to

exercise personal autonomy (right to choose and follow own

plan after deliberate analysis of factual information hasbeen provided).

3. It enhances practitioner credibility

o The patient has every reason to expect a higher

level of truthfulness from the health care

provider that others whom they deal with.

CONDITIONS WHERE PRINCIPLE OF VERACITY HAS BEEN VIOLATED:

1. In cases of DECEPTION, this includes:

a. keeping mum or silent about the truth

b. lack of truth telling or half truth

c. absolute lying

Reasons why deception is not acceptable or not

justifiable in the health care setting:

a. It interferes directly with patient autonomy

there is non-disclosure.


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b. Tolerance for lying damages the system of health

care delivery.

Patients believe lies only because truthfulness is

expected from health care givers. Once the patients

begin to look for deceit, an important element of

good health care delivery will be lost.

How does deception damage the health care system:

Lack of truth telling leads a slippery slope,

for while it gives comfort to the individual

(patient), it teaches all others involved

(family members, friends, housekeeping staff,

etc.) that health care professionals lie to

their patients when these others become sick

themselves, they will remember the previous

deception and will feel now that they cannot

rely on the work of professionals.

2. PLACEBO THERAPY that have harmful side effects and

without the consent of the patient

Placebo therapy administration of bio medically

inert (without inherent power of action) but which the

patient believes or feels therapeutic. (Edge and

Groves, 1999, pp.3). It is a therapeutic procedure,

which is objectively without specific activity fir the

condition being treated. (Alora, NTTC Module on

Autonomy, 1991,pp.8)

Reason why # 2 is non-justifiable: Because the

practitioner engages in no-disclosure and deception.


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CONDITIONS WHERE VIOLATION OF THE PRINCIPLE OF

VERACITY IS JUSTIFIABLE:

1. THERAPEUTIC PRIVILEGE doctrine which says that

the physician may intentionally and validly NOT

disclosure or may UNDERDISCLOSE information or

DELAY the truth, at the precise time, to the

patient and / or relatives about patients

condition, BASED ON A SOUND JUDGEMENT because of

the following reasons:

a. the patient is not strong enough to toleratethe truth, giving will cause potential harm

to the patient. Not giving will therefore,

prevent greater harm.

b. more time is needed to prepare the patient for

the unpleasant truth.

2. PLACEBO THERAPY is acceptable if the rules below

are followed / questions asked:

What is the condition being treated?

What are the motives of the therapy?

What is the placebo supposed to be?

Are there alternatives that are less misleading?

What is the patient staff relationship?

a. Placebos with active agents, which may have harmful

side effects, are not acceptable.

b. Placebos should not be given to patients without

consent. The patient must insist to be treated

with a prescription / medication.


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c. The doctor/health care provider knows that the

intervention does not have the objective

property necessary for efficacy.

d. The condition for which it is administered must be

known to have a high response rate toward the

placebo.

e. Alternatives offer greater evil or harm.

3. PATERNALISTIC LIE

Paternalism

o Belief that one should, on the basis ofdoing good for the patient, limit the

patients personal autonomy.

o Intentional limitation of the autonomy of

one person by another, where the person who

limits the autonomy appeals exclusively to

grounds of benefit to the other person.

o In the best sense, it is a conflict between

the basic principles of autonomy and

beneficence.

Paternalistic lie deception related to limiting

autonomy

Criteria for a justifiable paternalistic lie:

a. The lie benefits the person lied to, that is, the lie

prevents more evil that it causes for that particular

person.

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

occurs.


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c. 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.

d. Assuming equal circumstances, we would always be willing

to allow the violation of veracity.

e. Significant others are knowledgeable of the lie.

4. Research in psychosis may require deception for

successful completion without biasing results, if the

following conditions are met:

a. It is essential to obtain the information beingsought.

b. There is insubstantial risk for the subjects.

c. No other moral principle is violated.

IV. PRINCIPLE OF CONFIDENTIALITY principle that binds

the practitioner to hold in strict secrecy those

things learned about a patient in the course of

medical practice.

Confidentiality is an important aspect of trust

that patients place in health care professionals.

Professionals can be held morally and legally

liable for violation of this principle because

there are two rules that govern this principle in

the Patients Bill of Right, namely:

Rule 5 : The patient has the right to every

consideration of his privacy concerning his own

medical care program. Case discussion, consultation,


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examination and treatment are confidential and

should be conducted discreetly. Those not directly

involved in his care must have the permission of the

patient to be present.

Rule 6 : The patient has the right to expect that

all communication and record pertaining to his care

should be treated as confidential.

EFFECTS OF THE BREACH OF CONFIDENTIALITY:

1. If patients would discover that health care

professionals engage in such violations, fear of

disclosure will occur, leading to a great barrier

between practitioner and patient diagnosis and

treatment will suffer.

2. The fear of disclosure, in the past, has led minors

with STDs to suffer without care rather than to seek

aid, knowing that the system required the health care

system to notify their parents.

3. It will threaten to harm our patients, our

professions, and the society in general that depends

on the services we provide.

GUIDELINES FOR HEALTH CARE PROVIDERS RELATED TO THE

PRINCIPLE OF CONFIDENTIALITY:

1. To whom should medical information regarding the

patient be disclosed:

a. to the patient

b. if the patient is unable to comprehend the

information, information is given to whoever


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is in charge and makes decisions for the

patient (parents of a child).

c. to those who may be affected by the patients

health (children, subordinates, innocent 3rd parties,

employers, employees)

2. How much information should be told: All information

necessary in order to make decisions should be told

to whoever is concerned.

a. Information that the average person needs in

order to make the decision (for those whomakes decisions regarding the consent for

procedures or treatment-patient or surrogate).

What is to be done

What good / evil is to be expected

What ill effects may occur

How much will it cost him

What alternatives are available

Additional information the patient or surrogate

requests

b. How the illness may affect the capacity of the

patient to perform activities he is responsible

for (to be given to those affected by thepatients illness)

3. Situations when confidentiality can be broken:

a. Discussion of cases only in professional

settings in order to gather other opinions


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for the improvement of the care that will

be given to the client.

b. When the risk or danger of maintaining

confidentiality is greater than that of

breaking it, as when the patient or others

are endangered, confidentiality may be broken.

V. PRINCIPLE OF BENEFICIENCE mercy, kindness,

charity

- taking action to promote the welfare if other

people.

Conflict Autonomy patient difficulty of breathing

- patient says NO

VI. NON MALECFICENCE principle of doing no harm

- overriding principle in patient

care.

Documents

Basic Ethical Principles 1(2)