Question

You have been invited to give a guest lecture on healthcare ethics to an undergraduate class at a local college. Your primary theme is the interplay among the four biomedical ethical principles of autonomy, beneficence, nonmaleficence, and justice. In preparing your talk, describe how each principle may be derived from the others. Choose one of the principles, and discuss the potential impact on healthcare practice if that principle were consistently violated. Discuss how the four principles comprise a working unit and present a case study that features application of all of the principles.

Answer 1

The four principles of health care ethics are autonomy, beneficence, non-maleficence, and justice. All of these principles play a key role in ensuring optimal patient safety and care.

1. Autonomy: In medicine, autonomy refers to the right of the patient to retain control over his or her body. A health care professional can suggest or advise, but any actions that attempt to persuade or coerce the patient into making a choice are violations of this principle. In the end, the patient must be allowed to make his or her own decisions – whether or not the medical provider believes these choices are in that patient’s best interests – independently and according to his or her personal values and beliefs.

2. Beneficence: This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient. To ensure beneficence, medical practitioners must develop and maintain a high level of skill and knowledge, make sure that they are trained in the most current and best medical practices, and must consider their patients’ individual circumstances; what is good for one patient will not necessary benefit another.

3. Non-Maleficence: Non-maleficence is probably the best known of the four principles. In short, it means, “to do no harm.” This principle is intended to be the end goal for all of a practitioner’s decisions, and means that medical providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient.

4. Justice: The principle of justice states that there should be an element of fairness in all medical decisions: fairness in decisions that burden and benefit, as well as equal distribution of scarce resources and new treatments, and for medical practitioners to uphold applicable laws and legislation when making choices.

One hypothetical case study can be elicited here as part of explaining this which involves a patient who has an ovarian cyst that, left untreated, will result in kidney failure. An operation to remove the cyst is the best treatment, but the patient is frightened of needles and is against the surgery that would require a needle to give her anesthesia. The doctor must work with the patient to respect the fact that she dislikes needles and doesn’t want the operation (her autonomy), and needs to find a solution that would prevent her from going into kidney failure, which is in her best interest (beneficence). Although the surgery is the best choice, forcing the patient to accept the needle would be harmful to her (non-maleficence). Finally, the doctor needs to consider the impact that the patient’s choices might have on others if she starts to go into preventable kidney failure, she’ll need dialysis, which affects other people who need the same treatment (justice). So before making the final decision the doctor must consider all four principles of health care ethics, which will help the physician make the choice that will have the best possible benefits for both the patient and society.