Principles of Bioethics in Healthcare: Autonomy, Beneficence, and Justice
Principles of Bioethics in Healthcare
4PB. Goals of Bioethics
One of the main goals of bioethics is to provide healthcare professionals and researchers with a framework for rational decision-making when faced with ethical conflicts. The U.S. Congress established a national commission to identify these ethical principles, which should ideally not conflict with each other. When conflicts arise, these principles are ranked based on the specific situation. Reaching consensus among all parties involved is crucial, and this is the primary function of ethics committees.
Core Ethical Principles
Principle of Respect for Persons and Their Views (Autonomy)
This principle, also known as the principle of respect for persons in the Belmont Report, emphasizes the importance of individual autonomy. A person is considered autonomous if they possess:
- The ability to act (capacity in fact)
- The power to reasonably understand the scope and significance of their actions and be accountable for the consequences
Autonomy implies responsibility and represents an inalienable right for every patient. This means that the patient’s values, criteria, and preferences are paramount from an ethical standpoint.
Informed Consent
Informed consent is the ultimate expression of autonomy. It requires information, understanding, and voluntariness. The patient has the right to grant or refuse consent, and it is the physician’s duty to obtain it. Respecting patient autonomy has significant implications for doctors, including:
- Providing the patient with all relevant information for informed decision-making
- Facilitating clear communication using understandable language
- Being truthful about diagnosis, prognosis, and quality of life resulting from the proposed treatment, unless the patient requests otherwise
- Presenting different therapeutic alternatives
- Respecting confidentiality, as well as pledges and commitments made with the patient
This principle is crucial because the doctor-patient relationship often involves an imbalance of power. Patients may be in a position of vulnerability due to their lack of medical knowledge. While this asymmetry exists, it should never be exploited. The principle of autonomy protects patients from abuses of power and paternalistic behavior.
For an individual to be considered autonomous, they must be able to:
- Comprehend relevant information about their situation
- Understand the possible consequences of each decision
- Formulate reasoning based on relevant information and their own values
- Communicate their decision clearly and consistently
Generally, the principle of autonomy should be respected unless the patient is deemed incapable of making their own decisions.
Exceptions to the Principle of Autonomy
- Patients with a temporary decrease in autonomy: Non-urgent decisions should be postponed until the patient recovers their autonomy.
- Patients with no reasonable expectation of regaining autonomy but with known values and preferences (e.g., through advance directives): Their wishes should be followed.
- Patients who have never been autonomous or whose values and preferences are unknown: In these cases, the input of family members or other relevant individuals should be considered.
Principle of Beneficence and Non-Maleficence
These principles are closely related and often intertwined.
Beneficence
Beneficence involves taking positive actions to benefit others. It emphasizes providing benefits and eliminating harm. However, decisions based solely on beneficence can be problematic if they disregard the principles of autonomy and justice.
This principle encourages:
- Preventing or limiting harm
- Promoting good
- Ensuring the welfare of participating subjects
- Minimizing risks and maximizing benefits of research
Non-Maleficence
Non-maleficence means”do no harm” It emphasizes avoiding unnecessary harm to individuals. This principle has significant implications for healthcare professionals.
Principle of Justice (Fairness)
This principle focuses on the fair distribution of social goods based on need rather than merit. The allocation and distribution of resources in healthcare can either exacerbate or mitigate inequalities. Justice requires treating equals equally and unequals unequally, considering relevant factors when determining the appropriate treatment for each patient.
Healthcare policies are often justified based on the principle of justice. While the doctor-patient relationship primarily relies on beneficence and autonomy, the principle of justice plays a crucial role in mediating conflicts between these principles.
The Belmont Report (1978)
Commissioned by the U.S. government, the Belmont Report provides ethical guidelines for protecting human research subjects. It establishes a framework for addressing ethical dilemmas in research by outlining three fundamental principles:
- Principle of Respect for Persons (Autonomy)
- Principle of Beneficence
- Principle of Justice
- Principle of Non-Maleficence (added later)