The Four Principles

Question 1

What are the four principles?

Answer 1

Autonomy
Beneficence
Non-Maleficence
Justice

(plus attention to scope)

Question 2

What is the exception to these principles affecting moral life?

Answer 2

When one principle conflicts with another. In this case we need to make a judgement.

there is no straight forward method to give precedence to one or the other. no universalisable method to deal with the conflicts, and difference societies and cultures will give priority to one or theta run particular circumstances.

The approach does not deal with the scope of the principles. they are prefaces. to whom or to what does the principle apple to e.g. to whom do i owe an obligation to respect autonomy? these are scope issues and they are not answered by the approach.

They are useful but there are criticisms.

Question 3

Non-maleficence and beneficence

Answer 3

should be looked at together because even if you want to cure someone with medication, there is a risk of harm. Part of the Hippocratic oath is to benefit your patients and not to harm them. The benefit is in the benefit of health. Then you go into what is health or what is meant by health? The WHO definition is ideal but unattainable, maybe adjust by saying an adequate state of mental, social and physical wellbeing. That is the objective of health and is too broad. This sets up medicine to be some sort of arbiter and interferer of people’s wellbeing. The old fashioned idea is to help people who are ill, whose health is inadequate and this is a more adequate objective.

Question 4

We assume that net health benefits the obligation (non-maleficences and beneficence)

Answer 4

1. It requires to educate yourself in order to do that. Medical education is a premifacy obligation. In order to continue to practice you have continuing obligation to educate yourself.
2. Either individually into looking how to do tis better – e.g. research. Another commitment. Then you have tensions – doing medicine to benefit patients, or doing medical research in order to essentially benefit people medically. Aiming to benefit people in the future assuming that results will lead to something that will. different objective to looking after current patients and people in the future. These 2 can conflict. You want to deal with individual patient and do research as well. If you involve your patient in the research that can put them at harm. There are risks with getting involved. Difference between therapeutic and non-therapeutic research e.g. no designed to benefit individual but people in the future. Other clinical research can benefit the individual but also others.
3. Problems about beneficence and non-maleficence is what counts as benefit and wat counts as harm. People’s ideas often conflict. There are standard e.g. mend a broken foot. Sometimes not clear whether net benefit is more than risk of harm. Even though the Hippocratic primary objective is to aim for more benefit and minimal harm – you need to ask the patients and respect their autonomy. E.g. chemotherapy in cancer and the scientific evidence that it will increase the lifespan. You can give your advice and opinion but shouldn’t override the patient’s – issue of respect for autonomy. May come to different conclusions depending on what theory you go with e.g. utilitarian, consequentialist. E.g. quitting alcohol in order to increase life span, but patient might want to enjoy life in the mean-time and drink but can settle with a shorter life span.
4. Informed consent – important component of respect for self-autonomy.
5. Non deceit. We run our lives on the basis that people are honest with us. But not all the time e.g. playing poker. In normal life, the assumption is that you will be honest most of the time. E.g. Language could not have developed if people were not honest. You can then run your life based on non-deceptive answers to your questions. E.g. when with your patient, self-rules (not rule of others), respect for autonomy requires respect for rule of themselves.
6. Appointment - mutual promising. If you don’t go to the appointment, then you are not respecting people’s autonomy. E.g. if the operation delays and then late for clinic

Question 5

Justice

Answer 5

1. Something to do with equality. But Aristotle suggested that it’s not about treating everyone equally because then you can treat people unjustly. E.g. punishing everyone equally due to one person’s fault. Distributive justice – treat everyone equally e.g. give everyone the same amount of blood for blood transfusion. Problem is how to incorporate equality into justice.
2. Aristotle – equals should be treated equally and unequals treated unequally. Then you run into disagreement about what is inequality and equality. There is no universal theory of justice.
3. 3 areas of justice in medical practice: distributive justice, rights based justice, legal justice. Law and ethics are different but are highly integrated especially in terms of medicine. One includes thinking about the other. The obligation to respect morally acceptable laws  area of ethics and political philosophy. It’s morally acceptable if it comes about in a morally acceptable method/way – requires that people who are governed by the law have input into that law e.g. democracy. Hugely controversial.
4. Also areas with retribution and restoration and punishment. This is not as relevant in medical ethics, but some people would say not so. E.g. in distribution of resources, those who are blame worthy deserve less resources. Certainly relevant to aspects of medical practice e.g. awarding a job to someone who deserves the job who is better at it. It’s difficult to blame people with regards to distributive justice because how can you blame someone – smoking – is it their own fault that they get lung cancer, but were they pressured into as a child, or is their environment to blame and not the individual.
5. Universal theory might contain – you want some place for need. Need is a bottomless pit some people say because some can never have their needs met. But then what about those who have greatest need? But some may try to do the utilitarian approach by giving priority to those who will benefit the most and create greater welfare.
6. Area of justice is hugely important in medical ethics, in last 50 years notion of benefit and harm need to be augmented by respect of autonomy. This has now gone into the declaration of Geneva, but now they also need some mention of justice.

Question 6

Autonomy

Answer 6

capacity to deliberate about self-rule, how to rule your own life. To think about it and then to do something about it – although might not be able to do anything. But then with psychotic patients, they have capacity but with no logical premise.
Respect for autonomy – can see a consequentialist and a deontologist respecting autonomy.

Question 7

Moral code

Answer 7

there is an underlying moral framework that is universal

Question 8

ethics avoidance

Answer 8

defer the moral decision to the law, guidelines or another colleague

Question 9

virtue ethics

Answer 9

currently experiencing a renaissance. Character dispositions that are morally or unmorally justified. In order to decide whether a character disposition is virtuous or vicious, you need moral standards to assess them. We need virtues in order to implement moral theories to life, and to assess whether character disposition is virtuous, you can use these 4 principles.