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The principles of bioethicsCristina Gavrilovici, MD, MA, PhD
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1. Respect for Autonomy
2. Beneficence
3. Non maleficence
4. Justice
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1. Respect for Autonomy
Did you make any difficult choices recently?
If you visit a doctor, do you make treatmentdecision on your own or in discussion with otherfamily members and the doctor?
What are the limits to personal choice? (if any)
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1. Respect for Autonomy
rational agents are involved in making informed and
voluntary decisions.
in health care decisions, our respect for theautonomy of the patient would mean that the patienthas the capacity to act intentionally, with
understanding, and without controlling influences
this principle is the basis for the practice of "informedconsent" in the physician/patient transaction regardinghealth care.
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Respect for autonomy
autonomy = freedom + rationalityRights Duties
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Respect for autonomy
In the US: Engelhard: autonomy = permission
European concept of autonomy: shaped by a
Kantian framework: autonomy is built on moralresponsibility, commitment and concern forother human being
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Respect for autonomy
Is autonomy functioning as a leadingmoral principle in all societies?
4 models of patient-physician relationship:
paternalistic
informative
interpretative
deliberative
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What are the characteristicsof a society in which respect
for autonomy can override theother principles?
1. Patients would want to take decisions2. Patients would want to receive informations
3. Physicians would be able and willing to offer theinformation
4. Patients would need to understand the informationand remember it
5. Patients would appropiately debate the medical issues
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Respect for dignity
Dignity concerns the aspect of human life in whichautonomy is not enough to understand:
the emotions of the beginning and at the end oflife
the human body parts commercial
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Respect for integrity
This liberal concept states that no one is entitledto use ones body against ones will: all humans are
owner of the body (?).
If yes, are they entitled to sell parts of their
body if they wish to do so?
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Respect for vulnerability
Social constructed term
To what extent a vulnerable person canfreely and autonomously exercise his/her
rights?
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2. The Principle of
Nonmaleficence This principles requires of us that we not
intentionally harm or injury the patient,
either through acts of commission oromission.
we consider it negligence if one imposes a
careless or unreasonable risk of harm uponanother. In a professional model of care one maybe morally and legally blameworthy if one fails tomeet the standards of due care.
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2. The Principle of
NonmaleficenceThe legal criteria for determining negligence are
as follows:
1. the professional must have a duty to theaffected party
2. the professional must breach that duty
3. the affected party must experience a harm;and
4. the harm must be caused by the breach ofduty.
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3. The Principle of
Beneficence
Choose one example of atechnological advancement andidentify the benefits and risks of
this new technology!
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3. The Principle of
Beneficence
The ordinary meaning of this
principle is the duty of health careproviders to be of a benefit to thepatient, as well as to take positive
steps to prevent and to removeharm from the patient.
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3. The Principle of
Beneficence nonmaleficence is a constant duty, that
is, one ought never to harm anotherindividual.
beneficence is a limited duty.
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4. The Principle of
Justice Justice in health care is usually defined as
a form of fairness.
Distributive justice: some goods andservices are in short supply, there is not
enough to go around, thus some fair meansof allocating scarce resources must bedetermined.
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4. The Principle of
JusticeOur society uses a variety of factors as a
criteria for distributive justice, including thefollowing:1. to each person an equal share2. to each person according to need3. to each person according to effort
4. to each person according to contribution5. to each person according to merit6. to each person according to free-marketexchanges
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What can you do to make thesituation in the world betterfor others? Now and in the
future?