Foundations of bioethics
The four principles, ethical theories, paternalism, double effect and how to work through a case.
37 pages
Principle
- BeneficenceBeneficence is the duty to act for the patient's good: prevent, cure, relieve and help
- Justice: fair distribution and equal treatmentJustice asks us to treat like cases alike and to share health resources by fair, public criteria
- Nonmaleficence: «first, do no harm»A doctor must not cause the patient avoidable harm or expose them to risks that no benefit…
- Respect for autonomyA capable, informed person has the right to decide about their own body and treatment, even when…
- The principle of double effectAn act with one good and one bad effect may be permissible if only the good is intended and the…
Theory
- Ethical theories in brief: duty, consequences, virtue, casuistry, careEthical theories give different reasons for what is right: duty, consequences, character or…
- Foundations of bioethics: is, ought and valuesFacts alone do not tell us what we ought to do: a clinical decision joins data, values and…
- Justifying a moral judgement: top-down, casuistry, reflective equilibriumA moral judgement is justified by applying a theory, comparing with clear cases, or adjusting…
- Kantian ethics: duty and persons as endsFor Kant, an act has moral worth if done from duty, and every person is always treated as an end…
- Ranking the principles: Gracia's two levels (ethics of minimums and maximums)Gracia ranks the four principles on two levels: not harming and fairness bind everyone; autonomy…
- Rights theory: rights, duties and their limitsA right is a justified claim that binds others; every right has a matching duty held by someone
- The ethics of careThe ethics of care puts relationships, dependency and concrete attention to each person's needs…
- Utilitarianism in medicineUtilitarianism judges acts by their consequences: what produces the greatest total well-being is…
- Virtue ethicsVirtue ethics asks what kind of person the doctor should be; acting well is acting as a virtuous…
Topic
- Ethics and law: why legal is not always ethicalThe law sets the minimum that can be enforced with sanctions; ethics usually asks for more, and…
- Expanded access and compassionate useIt means giving a not-yet-approved product, outside a trial, to a seriously ill patient with no…
- How bioethics was bornBioethics arose in the United States between 1960 and 1980, when new medical technology and…
- How informed consent arose: the key court casesInformed consent was born in US courts: first the right to decide about one's own body, then the…
- Moral dilemmas and prima facie duties: specifying and balancingA prima facie duty binds unless it clashes with a stronger one; in a dilemma the norms must be…
- Moral distress, moral regret and residual obligationMoral distress is the strain of knowing what is right and being unable to do it because of…
- Moral pluralism, disagreement and civil ethicsIn a society with many moral outlooks, civil ethics looks for the shared minimums everyone can…
- Moral status: who counts, the five theories and degreesHaving moral status means a being's interests count in their own right; theories disagree on…
- Obligation, supererogation and moral ideals (the duty to treat in epidemics)Some acts are required; others, heroic or generous, go beyond duty
- Obligatory and ideal beneficence: the duty of rescueThere is a duty to help when someone faces serious danger, you can prevent it and the cost to…
- Paternalism: soft, hard and why it declinedPaternalism is deciding for another person, against their will, with the intention of doing them…
- Professionalism and the virtues of a doctorProfessionalism is a doctor's commitment to patients, colleagues and society, beyond knowing…
- The common morality, particular moralities and professional ethicsSome moral norms are shared by almost everyone; each group, medicine included, adds rules of its…
- The five focal virtues of the doctor and the ideal physicianCompassion, discernment, trustworthiness, integrity and conscientiousness are the virtues most…
- The four principles of bioethics (principlism)Four principles help frame an ethical problem in medicine: respect autonomy, do good, do no harm…
- The history of medical paternalism: from Hippocrates to PercivalFor centuries the doctor decided for the patient and hid the truth «for their own good»; that…
- Weighing risks, benefits and costs: cost-effectivenessComparing benefits with risks and costs is part of doing good; economic analyses help, but they…
Procedure
- How to work through an ethics case: four boxes and deliberationAn ethics case is worked through in order: first the clinical facts, then the patient's wishes…
- The deliberative method, step by stepDeliberating means analysing a case on three levels, facts, values and duties, to choose the…
International document
- Oaths and codes: Hippocrates, the Declaration of Geneva and the Colombian oathThe Hippocratic oath, the Declaration of Geneva and the oath of Colombia's Law 23 of 1981 sum up…
- The UNESCO Universal Declaration on Bioethics and Human RightsIn 2005 UNESCO adopted 15 principles of bioethics addressed to States, linking medical ethics…
- The WMA Declaration of Lisbon on the rights of the patientThe Declaration of Lisbon (1981) is the list of patients' rights that the World Medical…
- The WMA International Code of Medical EthicsThe WMA International Code of Medical Ethics (1949, revised in 2022) sets out in 40 paragraphs…
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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
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