Biomedical ethics test 2
Respect for autonomy
Recognize autonomous capacities
Treat person in manner that allows them to exercise capacities:
Autonomous actions or choices are not to be subjected to controlling restraints by others.
Principle of noninterference
Characteristics of respect for autonomy:
Prima facie standing: holds in normal cases unless it conflicts with a stronger obligation.
Asserts both a right and a correlative obligation.
Infringement must be justified by a competing stronger moral principle.
oViolation: unjustified breaching of a right
oInfringement: justified breaching of a right
Principle itself cannot determine when infringement is justified; needs context.
Though it is negative obligation has positive obligations inherent within it.
Fiduciary relationships: obligation is very strong
Respect for autonomy does not apply to persons who are non-autonomous
Principle of nonmaleficence:
Means the obligation to avoid harming or injuring others either intentionally or through
negligence. “above all, do no harm”
The obligation not to injure is more stringent then the obligation to take positive steps to
benefit others.
General aspect: All recognize an overriding moral requirement that medical practitioners
strive to serve the well being of their patients involves not harming them or placing
them in situations in which they could be harmed.
However, there are times when medical treatment may involve harm or risk of harm.
9/26/23 yay.
Weighing aspect: Medical intervention often involves tradeoffs of certain risks or harms
for benefits.
Therefore an assessment needs to be performed to evealuate the risk or harm in light of
the benefit.
oRisk/benefit assessment: assess the risk of harm in light of the possible benefit of
a particular medical procedure.
oHarms/benefit assessment: asses the known harms in light of the possible
benefit of a partiualr medical procedure(also called cost/benefit assessment)
Specific aspect: maintaining standard due care.
-A moral and legal obligation to act in a careful and professionally reasonable manner
in cases where one needs to impose risks on others
-Standard due care is met when:
oThe goals sought are weighty enough to warrant the imposition of certain
risks on others
oDue care is taken to keep these risks at a minimum level.
-Negligence: failure to maintain standard due care by failing to guard against risks of
harm to others; can lead to charges of malpractice.
Harm: the obstructing, defeating, or hindering the interests of one party by the invasive actions
of another party.
-Harms come in degrees ranging from trivial to serious.
-It is possible to be harmed (interests defeated) and not be hurt (awareness of harm).
-Non-maleficence has prima facie standing: not all invasions of another’s interests are
wrong. It is possible to infringe on another’s interests.
Principle of double effect
-The belief that there exists a moally relevant difference between the intended effects
of a persons action and the non-intended, though possibly foreseen, effects of the
action.
-The beneficial effect is seen as direct and intended while the harmful effect is
indirect and unintended, though perhaps a foreseen and fortunate side effect
-Because there is a moral distinction beteeen these effects, one is not held morally
blameworthy of an unintended, even if foreseen, harmful act
Conditions for double effect:
The intended action must not be intrinsically wrong,
The agent must intend only the good effect and not the bad effect. It may be
foreseen and even tolerated, just not intended.
The bad effect must not be a means to the end of bringing about the good effect.
The good which results musts outweigh the evil permitted.
PRINCIPLE OF BENEFICENCE: the obligation to help others further their
important and legitimate interests.
not just harming, but a farther obligation to contribute positively to others’ welfare.
Beneficence demands more than nonmaleficence – it places an additional obligation on
us besides simply not doing something (non-maleficence); it is a positive principle.
Two categories:
oGeneral beneficence: the obligation places upon me as a person to help other
persons
oSpecial beneficence: the obligation to help others due to a special relationship
which grounds the obligation
Most ethicists hold that there is some form of obligated general beneficence
Most acknowledge a threshold point to the obligation to help – a point where one is not
obligated to go further.
How do I determine the threshold to the obligation to help?
Interruption of ones plans: genuine threat or sacrifice to ones life liberty or basic
pursuits
Guidelines can be developed to help in determining what is involved in interruption of
ones life plans.
oSally has an obligation of beneficence terry if and only if:
oSally is aware of Terry’s need.
oTerry is at risk of significant loss or damage.
oSally’s action is needed to prevent the loss.
oSallys action would not present significant risks, costs, or burdens for Sally herself
oThe benefit of Terry would gain outweighs the costs to Sally.
Specific Beneficence:
Personal obligations: based on personal relationships: filial, familial, friendships.
Contractual obligations: based on explicit of implicit contractual relationships
Role-specific obligations: based on certain roles one has in society.
oNature of certain roles places an obligation to provide help beyond contractual
relationship.
Supererogatory actions: morally optional but morally praiseworthy actions performed for the
benefit of others above and beyond the call of duty
Characteristics of SA: neither required nor forbidden
Undertaken for others beyond the obligatory
Not necessarily extraordinarily demanding
The concept of justice:
The maintenance of what is just by the impartial judgement of conflicting claims and the
assignment of merited rewards and punishments,
Fairness: the obligation to treat people in a fair and impartial manner; ie. Equal
treatment
Just deserts: the obligation to recompense people what they fittingly deserve, both
reward and punishment
Entitlement: the obligation of giving a person his due or what he has a “right” to receive.
oDeserts are given because of something that you’ve done
oEntitlements are given because it is a right
An injustice occurs when someone has been denied an entitlemeant, has not received
their just deserts, or has been treated unfairly.
Therefore, it is unjust to reward or punish someone who does not possess the “relevant
moral property” the basis for fairness, just deserts, or entitlements
In attempt to establish a connection between the properties of persons and the morally correct
distribution of goods and services, benefits and burdens in society.
:what morally relevant properties, if any, give one person or group of persons an
entitlement to certain benefits or opportunities than others?
Why is distributive justice an issue? Because of a scarcity of resources and competition
between parties for those resources.
Aristotle said: Equals must be treated equally and unequals treated unequally.
Material principles of justice
Principle of equality – an equal share for all; no properties needed except to be human.
Principle of need – give to each as is needed
Principle of effot – give to each based on the amount of effot they have put forward
Principle or contribution – give to each based on the contribution they have made within
the given situation.
Principle of merit – give to each based on the quality of work done.
Principle of free-market exchange – give to each based on ability to pay
-Material principles of justice specify relevant properties under which fair distribution
can be attained. The key issue is determining which of these properties are relevant
to fairness and which are not. This must be decided contextually.
-In general, material principles are unjust when they attempt to make distinctions
between classes of persons that are actually similar in relevant respects, or fail to
make distinctions between classes that are actually different in relevant respects.
Egialitarianism:
Attemps to distribute goods and services as equally as possible across the board.
Social equality is emphasized over individual liberty.
Justification: the fact that we are all humans in need should take prioorty over
differences of the class we are born into or natural talents and endowments we are
born with
Persons in a co-operative society should strive to make more equal the unequal
situation of naturally disadvantaged members of a society. This done by taking from
the rich and giving it to the poor to equalize society.
Liberatarian:
Distributive justice consists not in equal results, but rather in unhindered and equal
working i=of fair procedures. All receive the same opportunity, but nit necessarily the
same results.
Individual liberty is emphasized over social equality.
Distribution of goods and services (like health care) are best left to the marketplace.
Ability to pay is available to all, since all have the liberty to make as much money as they
desire.
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