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● National Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research came up with the Belmont Report - principles used to justify their
policy recommendations
● 1970’s Georgetown University Tom Beauchamp and James Childress - solutions to the
moral problems in medical care and health policy by appealing to Moral Principles.
● The directives that flow from them are to be followed only when they do not cash with
those arising from a different principle
→ Example: In an effort to minimize harm to a pa ent with an aggressive medical
intervention, the physician might indirectly diminish a patient’s autonomy
-There should be a balance between the 4 ethical principles when it comes to decision
making.

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● “Doing what is right and good”; considered as ethically correct
● Requires health professionals to advocate on behalf of their patients in order to ensure
that they receive appropriate care
→ What we give to our pa ents should be something that is agreed upon to be good or
right
→ In essence, we follow the Gold Standard of Treatment, that is according to the Clinical
Practice Guidelines.

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● It requires health professionals to act for the benefit of their patients, where “benefit” is
construed with the same latitude that was used to interpret “harm” in the principle of
nonmaleficence. The principle of beneficence requires health professionals to advocate on
behalf of their patients in order to ensure that they receive appropriate care. It also
mandates paternalistic intervention when, because of age, disability, or disease, a patient
lacks the capacities for autonomous choice.
→ When you generate the largest ratio of good over harm, that is considered beneficial.
→ When pa ents do not have the capacity to decide, as doctors we tend to dictate which
is the better option, esp. for a particular treatmentIt requires health professionals to act for
the benefit of their patients, where “benefit” is construed with the same latitude that was
used to interpret “harm” in the principle of nonmaleficence. The principle of beneficence
requires health professionals to advocate on behalf of their patients in order to ensure that
they receive appropriate care. It also mandates paternalistic intervention when, because of
age, disability, or disease, a patient lacks the capacities for autonomous choice.

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The second principle is one of nonmaleficence, the requirement that health professionals
not intentionally harm their patients. This principle encodes the ancient medical dictum,
primum non nocere (above all do no harm). Because there are many different kinds of
harm, the principle of nonmaleficence supports many different rules, such as: “Do not
intentionally kill a patient,” and “do not intentionally cause a patient unnecessary pain or
suffering.” This principle could, for example, require that treatment of a patient cease when
it becomes a burden to her, even if that cessation hastens her death. This principle also
plays an important role in research ethics, for it prohibits experimentation that is likely to
harm subjects, even when they consent to it.

→ “For example, If stopping the treatment may result in the death of the pa ent, as doctors
you may espouse for that, especially, if you believe that if the treatment keeps on going it
would be more burdensome to the patient and to his family.”
● When no choice appears beneficial, choose to do the least harm

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● Self-governance or non-interference
● Focus on allowing people to make decisions that apply to their life
● An extension of beneficence, independence = control over life and experiences = desired
lifestyle
The principle of respect for autonomy requires others not to intervene when someone has
made an autonomous choice,

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This principle, then, usually rules out health professionals’ paternalistically interfering with
the decision making of competent adults.
respecting autonomy requires that people take positive steps to promote and protect the
capacity of agents to act autonomously. Health professionals are thus sometimes required
to increase the options available to a patient or to work hard to make sure that patients are
able to understand the decisions that confront them.
→ The pa ent should make the decisions on their own. And their decisions over the
treatment must prevail.
→ The pa ent should be aware of the risks and the benefits of whatever treatments or
procedures they are getting.
→ “When you are in the ER, they don't give you Informed consent because it is already
implied. You are in the ER, because you are sick, you wanted to be seen by a physician, or
you wanted treatment.”
→ “Similarly, when a pa ent goes to your clinic they don't sign Informed consent, because
they already gave you their consent by the fact that they want to see you.”
→ “But when a pa ent is admi ed, they have to sign the
Informed consent.”

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include distributive, criminal, and rectificatory forms of justice. The distributive version of
this principle is especially relevant in bioethical issues having to do with the morality of
institutions, where it requires that the benefits and burdens of the institution be shared
fairly. This principle might require, for example, that the state provide a certain level of
healthcare to all of its citizens. It also plays a significant role in evaluating the ethical
dimension of a scheme for rationing scarce resources (such as organs for transplant or beds
in an intensive care unit).

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Ethical theories are viewpoints from which individuals seek guidance for decision
making
● Each theory emphasizes different points - whether it’s decision making style or decision
rule
● Can be used together or individually
● Include:
→ Virtue
→ Deontology
→ U litarianism
→ Rights

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VIRTUE = ARETE; any kind of excellence
● Aristotle: “a kind of second nature’ that disposes us not only to do the right thing rightly
but also to gain pleasure from what we do”
● The virtuous individual - aim at the good of others and/or at certain noble ideals, rather
than seek to advance his or her own well-being
● Virtues a physician should have:
→ Pa ence
→ Temperance
→ Compassion
→ Integrity
→ Honor and Excellence
→ Honesty
→ Humility
→ Professionalism

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● Judges a person by his/her character than by the action that may deviate from his/her
normal behavior
→ Example: A student with a reputa on for academic misconduct caught chea ng
is likely to be judged as a cheater due to his previous history vs. a very religious and
diligent A student caught cheating might be thought of as having some personal
problems/crisis hence the action
▪ There would be a higher tolerance towards the first offender since its his first time to
do the act.
● Does not take into account a change in character
→ “What if someone wants to stop being a good person and wants to live life a little
dangerously?”

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This theory states that people should adhere to their obligations and duties
● Following obligations to another individual and society is ethically correct
● Very consistent decisions

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Categorical Imperative
→ Immanuel Kant
→ Act only in such a way that you would want your ac ons to become a universal law,
applicable to everyone in a similar situation
▪ “If I am subjected to this condition, I will decide this way and if you are subjected to the
same condition, you should decide the same way as I did.”
● Divine Command Theory
→ Ac on is right if God has decreed that it is right

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Example:
→ Lying: du ful person will never lie
→ Ac on may differ between persons
▪ “E.g In a situation wherein your friend did something wrong and you lie in order to
protect them.”
▪ “If your obligation is to your friend, then you will lie. If your duty is to God, then you will
tell the truth. It all depends on what your obligation is.”
→ Immanuel Kant: “At no point in me that you would say lying is ethically correct.”
→ “Technically speaking what you need to do is go around the facts in order to protect
certain professional secrets.”
● Does not take into account the consequences of action

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The choice that yields the greatest benefit is ethically correct
•Produces the most desirable result
•Based on one’s ability to predict outcome of action
•End justifies the means
•A person can choose to perform the act that benefits most people regardless of his
personal feelings or societal constraints OR
•Seeks to benefit the people through the fairest and most just means available

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● Cons:
→ Violates individual rights
● Example:
→ Mass Vaccina on - Herd Immunity

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Rights established by the society are highest priority
→ Consider ethically correct since the largest population endorses them
→ Society has to determine what rights should be upheld in light of what society’s goals
and ethical priorities are.
→ “Rights should always come with responsibilities”
▪ “We have the right to congregate, but we should clean up after we congregate”
▪ “We have the right to basic needs, but we also have a responsibility not to consume
everything or to abuse them”
→ “Rights of an individual ends where another individual’s rights begin”
● Cons:
→ Should be hand in hand with another ethical theory
● Examples:
→ Freedom of Speech
→ Doctor shaming - criminal offense

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Examples:
→ Freedom of Speech
→ Doctor shaming - criminal offense

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First, respect for the patient’s autonomy supports a policy of medical confidentiality,
requiring health professionals not to reveal to others private information discovered in the
course of caring for patients. According to this policy, health professionals should do
nothing to warn the sexual partners of their HIV-positive patient, as doing so would violate
his confidentiality. Second, if there is evidence that public disclosure of the patient’s
condition would harm him economically, socially, psychologically, or physically, the principle
of nonmaleficence would also urge against interfering with his activities.

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Third, however, the principle of beneficence requires health professionals to benefit others
by preventing harm to them, suggesting that they should warn the patient’s sexual partners
of their risk of infection. Finally, if the patient is intentionally trying to infect his partners
with the disease, his behavior is criminal, and the principle of justice will require health
professionals to notify the police; even if he is not intentionally trying to infect his patients,
justice requires that everyone take responsibility for the public health, and so health
professionals would have to alert public health authorities of his activity.

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To resolve this conflict, note that the two principles discouraging health professionals from
interfering with the patient’s activities—respect for autonomy and nonmaleficence—also
suggest that he should not be sexually active with partners who are ignorant of his
infection: Respecting their autonomy requires that he give them the information they need
to decide for themselves whether to be involved with him, and the principle of
nonmaleficence requires that he not harm them by exposing them to possible infection.
Accordingly, the moral requirement that health professionals protect third parties overrides
their prima facie duties of noninterference. Principlism supports health professionals’ duty
to warn the unsuspecting sexual partners of the HIV-positive patient.

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Deontology:
▪ Classical Hippocratic oath: “What I may see or hear in the course of the treatment or
even outside of the treatment in regard to the life of men, which on no account one must
spread abroad, I will keep to myself, holding such things shameful to be spoken about.”
▪ Modern version, Hippocratic oath: “I will respect the privacy of my patients, for their
problems are not disclosed to me that the world may know. Most especially I must tread
with care in matters of life and death. Above all, I must not play at God

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.”
→ Accordingly, the moral requirement that health professionals protect third par es
overrides their prima facie duties of noninterference
→ Moral requirement = Duty (Deontology

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