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Basic Ethics and Bioethics Principles in Health Care
Summary
The field of health care ethics addresses the wide variety of moral decision-making situations that can arise in medical practice. The areas of moral concern can include the clinical relationship between medical professionals and the patient, human subject research, the harvesting and transplantation of human organs, euthanasia, and abortion (McCarthy & Schafermeyer, 2004). Healthcare workers have an ethical obligation to care for their patients. At work, a medical professional constantly faces various ethical dilemmas. In such cases, ethical principles and moral rules provide help and guidance for medical practitioners (McCarthy & Schafermeyer, 2004). The knowledge of moral rules and ethics can significantly enhance the quality of healthcare provided by medical practitioners.
Ethical Theories
Aristotles Virtue Ethics Theory
One of the most influential theories in the healthcare field is Aristotles theory of virtue ethics. It states a persons character as the main determinative element in defining a persons moral virtues (Taylor). Exhibiting a good character could mean the presence of moral virtues, therefore rendering this person reliable in a decision-making situation. Unlike many other theories, Aristotles ethics do not dictate a specific set of rules and behaviors; instead, they promote moderation and relativism, which are essential in providing medical care (Aita & Richer, 2005). As such, the advantage of the theory is that moral virtues act as means between extremes, that is, right or wrong, depending on the situation. However, there is no answer to the question of what these virtues should be; they are time-changing or could be opposite for different people or cultures. A morally-driven, virtuous medical worker will care for patients health, remain compassionate and wise, placing their needs above his own.
Kants Deontological Theory
The deontological theory of Immanuel Kant uses rules, obligations, and duty to distinguish right from wrong. According to this theory, following a set of predetermined ethics, for example, truth-telling, helps differentiate a good decision from a bad one (Taylor). Kants theory is relatively easy to apply: if an action requires a person to lie or steal, then the said action is morally unethical (Aita & Richer, 2005). However, the main disadvantage of the theory is that it completely disregards the possible consequence of action or inaction (Aita & Richer, 2005). The theory can be applied to a variety of issues in the healthcare practice. For example, Kants ethics promote disclosing medical workers errors to the patients.
Casuistry
Casuistry is an ethical theory that uses a case-based method, resembling legal reasoning. According to casuistry, the best decision in a medical case with moral issues is to use prior similar cases for analogical reasoning. The theory is most useful in a conflict of rules or values, discerning workable solutions based on the previous cases with the accommodation of particular details. However, casuistry means a subconscious or nonconscious application of various norms and rules used in the practice of the previous cases, which can be reflective of widespread social bias (Taylor). Casuistry is useful in medical practice to determine similar relevant characteristics of the case, possible results, and consequences for the patient.
Ethical Principles
Autonomy
Autonomy is a moral right of a person, in a medical field that is a patient, to remain independent and self-determinate regarding ones body and health. The opposite of autonomy is paternalism, a view that patients should comply with whatever a healthcare professional believes is best for them (Wheat, 2009). This principle emerged at the end of the 20th century; however, even today, it is possible to face exceptions, violating patients right to autonomy due to religious, cultural, and social influence (Taylor). Such so-called exceptions can sometimes be not exceptional but objective and biased. The downside of fully respecting patients moral right to autonomy is allowing the patient to make the final decision, despite a chance of it being harmful. The example of practical use of autonomy principle in healthcare is listing all possible remedies, including the consequences of each, to the patient, disregarding the medical workers personal beliefs and opinions.
Beneficence
Another ethical principle is beneficence, which is mutually complementary to the principle of autonomy. Beneficence guides a person to do good for the sake of not oneself but for others (Aita & Richer, 2005). However, despite the fact that health care professionals being committed to beneficence rarely disregard the patients right to autonomy, it is not impossible for these principles to conflict with each other. As a core value of bioethics, beneficence was identified at the end of the 20th century; however, many contradicting theories exist, rendering the principle as fundamental or essential for morality (Taylor). Sometimes, overemphasizing this principle in perusing the best interests of one party can lead to harming or endangering a different yet relative party, for example, a patient and his family. In medical practice, a healthcare professional is always expected to act beneficently toward the patients, in their best interest.
Non-maleficence
One of the oldest ethical principles, non-maleficence, is similar to beneficence and encourages to do no harm, intentional or unintentional. The principle was initiated with the Oath of Hippocrates and is sometimes considered the primary or the most crucial principle (Aita & Richer, 2005). Unintentional maleficence is usually a product of ignorance or negligence of the health care workers (Taylor). However, there are debates where the risk of some harm to the patient can be unavoidable (Aita & Richer, 2005). Violating the non-maleficence principle usually can prove to be a serious legal offense, with severe consequences to the patient and the medical worker involved. The knowledge of such possibility can sometimes cause fear in a healthcare worker, preventing them from taking action or accepting a patient. An example of committing to the non-maleficence principle in medical practice is a careful calculation of the proper dosage in prescribing medication.
Justice
Justice is an ethical principle that determines the extent to which the medical service is provided equally to all in a healthcare context. The principle is also considered to be established by the Greek philosopher Hippocrates (Taylor). Besides working with patients directly, the principle of justice can be applied in the context of allocation of resources and formulation and implication of policies (Wheat, 2009). The violation of the principle of justice in medical practice is usually associated with one of the demographic distinctions, for example, gender or race. The defying of this principle is one of the easiest for patients to recognize. As such, it can sometimes lead to incorrect assumptions and accusations towards the medical workers, despite the accusers lack of knowledge of the cases. Applying the principle of justice in healthcare practice usually involves similar cases to be treated the same and different cases to be treated with recognition of said differences.
References
Aita, M., & Richer, M. C. (2005). Essentials of research ethics for healthcare professionals. Nursing & health sciences, 7(2), 119-125.
McCarthy, R. L., & Schafermeyer, K. W. Introduction to health care delivery: A primer for pharmacists. (2004). Jones and Bartlett Publishers.
Taylor, S. C. Health care ethics. Internet Encyclopedia of Philosophy. Web.
Wheat, K. (2009). Applying ethical principles in healthcare practice. British Journal of Nursing, 18(17), 1062-1063.
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