Introduction to the Four Principles of Medical Ethics.
Introduction to the Four Principles of Medical Ethics.
The most commonly used framework for current biomedical ethics centers on four core principles. These four principles are:
1. Respect for autonomy – requires respect for the decisions made by autonomous persons.
2. Beneficence – requires that one prevents harm to others, provides benefits, and balances those benefits against risks and costs.
3. Nonmaleficence – requires one not to cause harm to another.
4. Justice – requires the fair distribution of benefits, risks, and costs to a general population.
ORDER CUSTOM, PLAGIARISM-FREE PAPER
It is important to recognize that these principles do not function as moral absolutes or laws. This is a frequent misconception. Individual principles should never be conceived “as trumps that allow them alone to determine a right outcome” (Beauchamp & Childress, 2013, p. viii). Rather, principles are prima facie binding. By prima facie, one means that principles or duties must be fulfilled unless they conflict on a particular occasion with an equal or stronger principle, duty, or obligation (Ross, 2009). For instance, one might justifiably break patient confidentiality to prevent someone from harming or killing another person or disclose confidential information about a person to protect the rights of another person. Patient confidentiality must be protected unless a higher principle, such as preventing serious harm to another person, takes justifiable moral precedence. According to Childress (1994), the most defensible principle-based frameworks envision bioethics as principle-guided, not principle-driven.
Because these principles can be derived from different worldviews, traditions, and philosophies, they are necessarily general and broad in their definition and application and provide little direct help with actual moral decision-making and moral rules. Different worldviews interpret these principles in different ways. Disagreements in bioethics usually result from different views about what each principle entails, what they actually mean, and how they ought to be applied.
The way principles are specified and balanced in any given case scenario is also determined by prior moral commitments. Thus, the way in which a Muslim would apply the four principles to a case would differ from the way a secularist would apply them. While the four principles can provide a framework and common language within a pluralistic culture, they still require definition and content, specifying what they mean in given concrete situations and often require balancing two or more of the principles when they come into conflict.
As discussed in this and earlier chapters, a worldview has a significant effect on how one approaches moral dilemmas. Figure 3.2 shows a very simplified hierarchy of moral thinking that begins with one’s worldview that informs one’s ethical theory, which subsequently provides definition and meaning to the principles. From here, one’s understanding of the principles can then be applied to specific ethical cases. It is much more complicated than a simple diagram can convey, but the purpose is merely to illustrate a general concept.
Figure 3.2
Relationship Between Worldview, Theories, Principles, and Ethical Decisions
How one begins developing an approach to ethics is dependent, consciously or subconsciously, on a comprehensive and consistent worldview. Such a worldview includes, among other things, what is supremely valued and contributes to true human fulfillment that people are to desire. It is also dependent on one’s view of the nature of reality and the existence, or lack of, transcendent universal moral norms that are binding standards of right and wrong that exist for everyone at all times and in all places, independent of human reason and will. In other words, is what one terms “right” and “wrong” objective and discovered (i.e., in the natural order or through divine revelation, as in the Christian worldview) or subjective and invented (i.e., through philosophical reasoning alone as in most secular theories)?
Ethical or moral theories are those abstract reflections and arguments about ethics along with their systematic justification. These theories are each informed by a given worldview, such as atheism, pantheism, or theism. Three of the most common classes of philosophical ethical theory—deontology, utilitarianism, and virtue ethics—are listed in Figure 3.2. A purely secular worldview develops each of these moral theories beginning with human reason alone, while a Christian view begins with God’s revelation in the Bible.
Deontology is an ethics based on duties, obligations, or rules. It describes what one ought to do regardless of outcome or motive. In a secular approach, those duties or rules are derived solely from human reason. For the Christian, a form of deontology would be based on God’s commands, such as the Ten Commandments, which are reflections of God’s own character and goodness.
Utilitarianism is a form of ethical theory that looks at the consequences of one’s actions and is usually formulated as seeking the “greatest good for the greatest number.” The good that is being sought in secular forms of utilitarianism usually involve maximizing pleasure and minimizing pain or are centered on forms of perceived human fulfillment. A biblical view of the goals of one’s actions is centered on seeking God’s kingdom first (Matthew 6:33) and relying on God’s providential control of the outcomes of actions that are faithful to his commands.
An ethical theory of virtue focuses on the inner character of a person along with his or her motives. Which character traits are considered virtues and vices, depend on a given ideal of human nature, or what the purpose is of being human. Secular approaches to virtue ethics give many different answers to the purpose of human nature or deny there is any purpose or even human nature at all. According to the Westminster Shorter Catechism, one of several summaries of Christian teachings used by several Protestant denominations since the 17th century, a Christian approach to virtue ethics is based on being made in God’s image with the purpose of “glorifying God and enjoying him forever.” Furthermore, a Christian’s motive and character are always informed by the love of God. A biblical summary of those character traits, or virtues, that Christians should reflect is found in Galatians 5:22–23 and are called “the fruit of the Spirit.”
The Christian worldview provides a comprehensive basis for holding together three aspects of ethical reflection: direction for Christian living (the character of God as reflected in his will and commands), motive and character of Christian living (as reflected in the love of God and the fruit of the Spirit), and the goal of Christian living (to seek God’s kingdom while glorifying him and enjoying him forever). Secular approaches to these three aspects of ethical reflection remain in tension, as human reason alone is unable to provide a unifying and comprehensive ethical theory (Reuschling, 2008). A Christian approach to applied ethics, as based on the Christian worldview, is illustrated in Figure 3.2 Introduction to the Four Principles of Medical Ethics.
Introduction to the Four Principles of Medical Ethics.