The Four Principles of Bioethics
Ethical Issues in Biomedical Engineering
The Four Principles of Bioethics
Beauchamp and Childress introduced bioethics principles to resolve ethical issues. The four ethical principles include non-malfeasance, beneficence, and justice.[1]The four principles act as a foundation in the field of medical ethics as well as essential for understanding the current approach to ethical consideration in healthcare. Different arguments focus on identifying the most significant principle than the other among the four. Moreover, in a diverse community, the guidelines of what principle should consider first need to be broadly acceptable among all different cultures and religions. In clinical medicine and scientific research, all four principles get applied to guide in discovering the care provider’s moral duties within that situation. Health professionals should concentrate on the responsibility of maintaining the best decision for the patients by achieving the balance between the four principles indecisions. Therefore, none of the four principles exist as more significant than the other in the healthcare systems while making different decisions by the care providers.
The first principle exists as respect autonomy, which means respect other’s rights to decide for themselves. Respect autonomy offers the opportunity to others to possess freedom hence making their choices. Gillon believes that autonomy should not only be respected but also encouraged and nurture its development.[2] However, in the field of health, making a decision in some cases requires sufficient knowledge about the choices and their consequences. The point highlights the idea that autonomy cannot persist as most critical of the four principles. For instance, while handling medical decisions involves children, parents would play a key role in decisions instead of their kids[3]. In such a scenario, decisions made for another person hence parental authority, persist as a more fitting description than parental autonomy.
Moreover, when religion or culture occurs as dominant, any decision made originates from belief or fear, nothing else for knowing the best for oneself. Respect for the autonomy of the patient might require the health professional to assist the patient in making their own informed choices. For example, if practicing any kind of worship can cause any damage or reduce the chance of patient to recover, then the practitioner’s responsibility to inform the patient with sufficient information to make their own decision.[4]Besides, respect autonomy happens as a challenge to apply in urgent situations when fast and immediate action needs to be done.[5]In light of that, autonomy should be explained as the individual right to decide for himself or herself when the individual is aware entirely of the consequences of that decision on himself or herself and others.
The second principle occurs as beneficence, which requires that healthcare professionals have the obligation of doing well for the patient involved. As a result, healthcare professionals must develop and maintain skills and knowledge that consider the individual circumstances of all patients and strive for net benefit. However, adopting this principle frequently puts the care providers in direct conflict with some other principles. To ensure beneficence, medical practitioners must take affirmative steps to prevent harm. It has been argued that beneficence exists as a fundamental obligation that should always consider first unless it conflicts on a specific case with an equal or more influential principle.[6]In other words, doing the right for a patient may conflict with the principle of respecting the autonomy of other persons. For example, in the case of rejecting a lifesaving blood transfusion, some would agree to ignore other’s beliefs to save a life. Healthcare providers may end up have a duty to interfere with the decisions of others to make sure the safety of patients at the end. Beneficence brings an obligation on medical practitioners to bring about good in all their actions.
Non-maleficence exists as the thirds principle, which requires that a procedure does not harm the patient involved or others in society. The definition of harm may differ from one society to another or from beliefs to others. In the field of medical, the obligation of not harm others may follow steps such as no harm, where harm persists as unavoidable, obligate to minimize the harm done, and finally try reducing the risk of harm to others. Some medical decisions get operated under the assumption that they eliminate any harm or at least minimizing harm by pursuing the greater good. However, limited success rates, in some cases, result in uncertain overall consequences. As a result, the emotional state of the patient may get impacted unexpectedly in a negative manner.
In some cases, healthcare providers encounter difficulties in the successful application of non-maleficence due to do no harm principle. The principle intends to form the objective part for all health professional’s decisions, which implies that healthcare providers should consider whether other individuals or society could get harmed by a decision made, even if intended for the benefit of an individual patient.[7] In the case of highlighting some instances, the nuances of non-maleficence, and the cases of failure by doctors to recognize the difficulties of their conduct as possible causes of harm to the patient. Any kind of neglect or abdication of medical rules, renunciation of moral standards, and ignore of codes of practice happens as identical to a commission of maleficence. [8]Similarly, an unsuccessful act according to the goal of the practice, or to discharge clinical responsibilities with necessary care persist as harmful. The might appear challenging for most health providers as they have a limited understanding of the concept of harm. However, different arguments point out that the wrong action lacks the considerations as a tendency of harming another person, thus accepting some harmful activities. Therefore, causing harm or pain does not necessarily mean making mistakes by the involved parties instead, their specific interests may be superseded at a given point in time.[9] Similarly, wronging an individual never equate to harming people. For instance, in an emergency department, during disaster scenarios, when helping and treating one patient can result in increasing the pain of another patient.[10]
The fourth principle persists as justice, which obligates to achieve fairness in all medical decisions, including treatments or medical resources. All health providers must provide patients with what they owe or deserve. Unlike medical life, the obligation of treating all people equally, fairly, and impartially occurs as more straightforward to implement in public life than medical life. The principle of justice imposes unfair burdens on medical practitioners to provide equal treatment and services for people. With scarce resources, the limited number of health providers, and a large number of those in need of care, fairness can be difficult to apply. Emergency care acts as an excellent example of a situation where the emergency department role exists impeded since the number of patients waiting to be seen, undergoing assessment and treatment, or waiting to leave exceeds the physical or staffing capacity of the emergency department.[11]Thus, ethical dilemmas get created due to the unequal available treatments or sources to all people. Therefore, the principle of justice never means each person or group must get an equal share of the scarce resources, but rather a fair share based on appropriate criteria and principles like equality, utility, and priority to the worst-off.[12]
Conclusion
To sum up, it can be concluded that the four principles integrate hence all of them serve a crucial role in healthcare decision making. As a result, in order to accomplish one principle, many conflicts would occur with the rest of the principles hence medical practitioners require them all to deliver quality care to the patients. Besides, arguments focus on which principles of bioethics should get valued the most in terms of the significances in the preservation of life, in maximizing patients’ well-being, in cost avoidance, and risk reduction. All the four principles of bioethics possess implications of being the most critical obligation hence should always apply universally to all cases in the healthcare system. Discussing different circumstances and scenarios, health professionals often find themselves in a situation that it becomes difficult for them to decide on what bioethics principles they should consider first. From this observation, decision making in clinical setup requires a need by academics and medical professionals, among others, to keep on reflecting on the four principles of bioethics such as determining their applicability to different cases that arise in the biomedical field. Therefore, the four principles play a fundamental role in the field of biomedical and should get incorporated equally since no one exists as more significant than the other.
Bibliography
Aacharya, Ramesh, Chris Gastmans, and Yvonne Denier. “Emergency Department Triage: an Ethical Analysis.” BMC Emergency Medicine 11, no. 1 (July 2011). https://doi.org/10.1186/1471-227x-11-16.
Baines, Paul. “Making Medical Decisions for Children: Ethics.” Birmingham University, September 2015. http://etheses.bham.ac.uk/6511/1/Baines16PhD.pdf.
Beauchamp, Tom and James Childress. PRINCIPLES OF BIOMEDICAL ETHICS. S.l.: OXFORD UNIV PRESS US, 2019.
Gillon, Raanan. “Ethics Needs Principles-Four Can Encompass the Rest-and Respect for Autonomy Should Be ‘First among Equals.’” Journal of Medical Ethics. Institute of Medical Ethics, October 1, 2003. https://jme.bmj.com/content/29/5/307.
Johnson, Amber. Medical Ethics 101. Accessed February 20, 2020. https://web.stanford.edu/class/siw198q/websites/reprotech/New Ways of Making Babies/EthicVoc.htm.
Morrison, Eileenand Elizabeth Furlong. Health Care Ethics: Critical Issues for the 21st Century. Burlington, MA: Jones & Bartlett Learning, 2019.
Motloba, Pagollang. “Non-Maleficence – a Disremembered Moral Obligation.” South African Dental Journal 74, no. 1 (February 2019). https://doi.org/10.17159/2519-0105/2019/v74no1a7.
Munyaradzi, Mawere. “Critical Reflections on the Principle of Beneficence in Biomedicine.” The Pan African medical journal. The African Field Epidemiology Network, 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325067/.
Torry, Malcolm. “Ethical Religion in Primary Care.” London journal of primary care. Taylor & Francis, April 18, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537594/.
[1] Beauchamp and Childress. “PRINCIPLES OF BIOMEDICAL ETHICS.” 100
[2] Gillon. “Ethics Needs Principles-Four Can Encompass the Rest-and Respect for Autonomy Should Be ‘First among Equals.’’ 310
[3]Baines. “Making Medical Decisions for Children: Ethics.” 8
[4]Torry. “Ethical Religion in Primary Care.” 50
[5]Aacharya, Gastmans, and Denier. “Emergency Department Triage: An Ethical Analysis.”5
[6]Munyaradzi. “Critical Reflections on the Principle of Beneficence in Biomedicine.” 4
[7]Johnson. Medical Ethics 101
[8]Morrison, and Furlong. Health Care Ethics: Critical Issues for the 21st Century. 42
[9]Motloba. “Non-Maleficence – a Disremembered Moral Obligation.” 40
[10]Aacharya, Gastmans, and Denier. 7
[11]Aacharya, Gastmans, and Denier. 8
[12]Aacharya, Gastmans, and Denier. 8