Principlism

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Principlism

BIRTH OF BIOMEDICAL ETHICS

&

BASIC PRINCIPLES OF

BIOMEDICAL ETHICS

INTRODUCTION TO MEDICINE

Lecture 12

November 27, 2012

Lecturer: ADÉL TÓTH, MA, PhD


MAIN POINTS OF THE LECTURE

1. Birth of biomedical ethics

2. Differences of biomedical ethics

and traditional medical ethics

3. Basic characteristics of biomedical ethics

4. Deontological and utilitarian ethical

theories as final appeals in moral reasoning

in bioethics

5. Four principles of biomedical ethics


BIRTH OF BIOMEDICAL ETHICS - 1

After World War II: Claim for

the revival of traditional medical

ethics

MOTIVES ENCOURAGING

CHANGES:

1. Historical events: Abuses

committed in the name of medicine

– urged construction of regulations

on research on humans

• Nuremberg Code, 1946

• First ethics committees, 1966

• Declaration of Helsinki, 1967

• Belmont Report, 1979


NEED FOR CONTROL OVER MEDICAL

RESEARCH – Tuskegee syphilis study (1932-72)


CONTROL OVER MEDICAL RESEARCH

Nuremberg Code – 1946-47

• The voluntary consent of the human subject is essential.

• The experiment should yield fruitful results for the good of

society.

• The experiment should be based on the results of animal

experimentation and a knowledge of the natural history of the

disease.

• The experiment should avoid all unnecessary physical and

mental suffering and injury.

• No experiment should be conducted where there is an a priori

reason to believe that death or disabling injury will occur.

• The degree of risk should never exceed the humanitarian

importance of the problem to be solved by the experiment.

• Proper preparations should be made to protect the

experimental subject against even remote possibilities of

injury, disability, or death.

• The experiment should be conducted only by scientifically

qualified persons.

• During the course of the experiment the human subject

should be at liberty to bring the experiment to an end.

• During the course of the experiment the scientist in charge

must be prepared to terminate the experiment at any stage, if

he has probable cause to believe that a continuation of the

experiment is likely to result in injury, disability, or death to the

experimental subject.


BIRTH OF BIOMEDICAL ETHICS - 2

2. Medical development

• Rapid evolution of medical technology

• Changes in disease patterns (infectious→chronic)

3. Social and political changes

• Civil right movement – emancipation of patients

• Acceptance of value pluralism, diversity of cultures

• Growing public interests in health care issues

4. Theoretical need

• Traditional medical ethics = etiquette

• Traditions not always helpful in new situations

• Analytical philosophy: Philosophical foundation of new medical ethics

(bioethics, biomedical ethics, philosophical medical ethics)

USA, 1979 - Beauchamp TL, Childress JF.

Principles of Biomedical Ethics (authors: philosopher,

theologian); in 2008: 6 th edition


PRINCIPLES OF BIOMEDICAL ETHICS


DIFFERENCES OF BIOMEDICAL AND

TRADITIONAL MEDICAL ETHICS

Interdisciplinary character

- TRAD. ETHICS: Elaborated by doctors

- BIOETHICS: Combining the fields of philosophy and

medicine into one discipline, elaborated by philosophers,

theologians, lawyers, physicians, paramedical staff

Wider scope

- TRAD. ETHICS: Doctor-patient relationship

- BIOETHICS: Doctor-patient relationship, biomedical

research, justice in health care system

Philosophical foundation

- TRAD. ETHICS: Based on traditions and customs

- BIOETHICS: Based on analytical philosophy


BASIC CHARACTERISTICS OF

BIOMEDICAL ETHICS - 1

1. Applied ethics: Application of ethical theories

and principles common in other fields of life to

medical issues

2. Deductivism: Moral judgements are deduced

from previously existing ethical norms

3. Hierarchy of moral reasoning:

Ethical theories


Principles


Rules


Particular judgement or action


BASIC CHARACTERISTICS OF

BIOMEDICAL ETHICS - 2

4. „Four principles” approach: Respect for

autonomy, non-maleficence, beneficence, justice – form

a consensus between the two main ethical theories

(deontology – utilitarianism)

5. Prima facie moral obligations: Moral duties are

binding unless they are in conflict with equal or stronger

duties; prima facie moral duties should be ranked and

then the strongest should be chosen; prima facie duties

leave moral traces if they are overridden; in practice

respect for autonomy has gained precedence

6. Procedural ethics: Not the content of a moral

judgement but the method of the ethical reasoning

counts; if the four principles are taken into account, the

moral decision should be right


ETHICAL THEORIES – 1

DEONTOLOGY

Ethical theories: Being on the top of moral

justification in bioethics; final, overriding appeal

Deontological ethical theories: „Deon” =

duty; duty-based ethics; an action is right if it is

in accordance with moral duties

Consequentionalist or utilitarian ethical theories:

an action is right if it maximises the good, nonmoral,

intrinsically valuable consequences


FOUR PRINCIPLES OF BIOETHICS - 1

Principle of respect for autonomy

Autonomy: "autos" (self) and "nomos" (rule)

Meaning: Self-rule or self-governance, being one's own

person, acting on the basis of thought and reasoning

Forms of autonomy: autonomy of thought, will, and

action

Respect for autonomy

• Recognising the patient’s right to self-governance

• Entitled only for those patients who are capable of selfdetermination

• An autonomous agent's actions and choices should not

be constrained by others

Principle of respect for autonomy: prima facie

moral duty


FOUR PRINCIPLES OF BIOETHICS - 2

Principle of non-maleficence

Non-maleficence: One ought not to inflict evil or harm

(what is bad).

Core of morality:

• "Don't kill!”

• "Don't cause pain!”

• "Don't disable!”

• "Don't deprive of freedom or opportunity!”

• "Don't deprive of pleasure!"

Prima facie moral duty

In health care: duty of due care


FOUR PRINCIPLES OF BIOETHICS - 3

Principle of beneficence

Scope:

• Prevention of harm (screening programs, vaccination)

• Removal of harm (administration of drugs, surgery)

• Provision of benefit (biomedical research)

Two parts of principle of beneficence:

• Positive beneficence: Provision of good, prevention of harm,

removal of harm

• Principle of utility: Balancing benefits and harms

Professional duty: Using medical expertise to respond

to the patient's request for help

Requirements determined by duty of beneficence:

Promotion of health, restoration of health, relief of symptoms,

restoration of function or maintenance of compromised function,

saving or prolonging life, education and counselling of patients


FOUR PRINCIPLES OF BIOETHICS - 4

Principle of justice

Meaning and types of justice

Justice as fairness and desert: When a person has been given what

that person deserves or can legitimately claim

Distributive justice: Justified distribution of benefits and burdens

Comparative justice: When what a person deserves can be determined

only by balancing the competing claims of others

Non-comparative justice: When desert is judged by a standard

independent of the claims of others

The Aristotelian principle of formal justice: Equals should be

treated equally and unequals unequally in proportion to their relevant

inequalities

Material principle of justice: relevant properties: basis of distribution

• To each person an equal share

• To each person according to individual need

• To each person according to individual effort

• To each person according to societal contribution

• To each person according to merit


CRITICISM OF BIOETHICS

Not universal, not neutral – culturally

bound („ethics of Western-type, rational,

white males”)

Narrow view on ethics – Principlism: using

conflicting mid-level principles (Why only

these four principles are used?)

Narrow view on medical practice –

neglecting the lived moral experience of

patients and professionals


NEW APPROACHES TO MEDICAL

ETHICS

Clinical ethics – trying to exclude philosophy

Virtue ethics – ethics of care

Feminist ethics – emphasizing female

characteristics and their consequences

Narrative ethics – focusing on lived experience

Phenomenological ethics – being descriptive

Interpretive ethics – emphasising cultural and

historical aspects


THANK YOU

FOR YOUR

ATTENTION!

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