Principlism in Bioethics

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Questions and Answers

What is a central concept in narrative ethics?

Use of cases as laws for legal judgments

Application of universal moral principles in all circumstances

Strict adherence to professional codes of conduct

Analysis of stories for analytical and reflective learning (correct)

Which of the following virtues is NOT mentioned as important for a caring person?

Responsiveness

Competence

Judgment (correct)

Attentiveness

What does the casuistry approach primarily rely on?

Interpretation of rules or past cases (correct)

Psychological assessments of individuals

Abstract ethical theories

Personal anecdotes and experiences

What are rights attached to groups in society primarily considered as?

Collective rights Signup and view all the answers

Which step is NOT part of the ethical decision-making process outlined?

Identify emotional impacts Signup and view all the answers

What defines a positive right?

A duty of support or assistance Signup and view all the answers

What is a common weakness associated with using casuistry in clinical practice?

Inadequate experience of junior practitioners Signup and view all the answers

What is the first step in the decision-making process regarding ethical dilemmas?

Identify the ethical problem Signup and view all the answers

What are the four principles of principlism in healthcare ethics?

Autonomy, Non-maleficence, Beneficence, Justice Signup and view all the answers

Which principle emphasizes the importance of not causing harm to patients?

Non-maleficence Signup and view all the answers

Which ethical theory focuses on the consequences of actions to determine their moral worth?

Consequentialism Signup and view all the answers

What does the principle of beneficence require healthcare providers to do?

Act in the best interest of the patient Signup and view all the answers

The principle of justice in healthcare primarily deals with which of the following?

Fair distribution of resources Signup and view all the answers

What does the principle of autonomy emphasize in patient care?

The patient's right to make informed decisions about their health Signup and view all the answers

What does the principle of Deontology primarily focus on?

Universal moral duties Signup and view all the answers

According to Virtue Ethics, what is necessary for human flourishing?

The actions of a virtuous person Signup and view all the answers

Which principle is known to be an overriding principle in bioethics but is not considered absolute?

Autonomy Signup and view all the answers

How does Communitarianism differ from Liberal Individualism?

It prioritizes community interests above individual rights Signup and view all the answers

Which of the following is a common ethical dilemma in the beneficence principle?

Balancing the need for treatment against potential harm Signup and view all the answers

What is a fundamental aspect of Liberal Individualism?

Rights are interconnected with responsibilities Signup and view all the answers

Which of the following concepts is a limitation of Kantianism?

It does not provide guidance on conflicting duties Signup and view all the answers

What is a criticism of the Ethics of Care approach?

It can overlook broader ethical principles Signup and view all the answers

What role do emotions play in Virtue Ethics decision-making?

They must be incorporated alongside facts Signup and view all the answers

Which of the following explains a challenge of predicting future consequences in healthcare ethics?

Difficulties in forecasting outcomes accurately Signup and view all the answers

Study Notes

Principlism

Bioethicists Beauchamp and Childress coined the term "principlism," which is a 4-principle approach when analyzing ethical situations in healthcare.
The four main principles are:
- Respect for autonomy (right for self-determination)
- Non-maleficence (avoid causing harm)
- Beneficence (promote overall benefit)
- Justice (for one or more individuals)

Autonomy

Respect patients' freedom of thought, intention, and action in matters of their health.
Ensure patients understand diagnosis, treatment options, prognosis, success, risks, side effects, costs, etc.
Promote patients’ autonomy and warn patients about to take harmful decisions.
Execute autonomy through informed consent, confidentiality, protection of privacy, and veracity.
Although autonomy is an overriding principle, it is not absolute.

Non-Maleficence

It means to "first, and foremost, do no harm.”
Therapy should not harm the patient or others in society
Justify double-effect therapy.
Violation of non-maleficence principle may attract litigation.

Beneficence

Act in the best interest of the patient and overall good.
Develop and maintain knowledge and skills through continuous learning.
Consider and do the best within the specific circumstances of the patient.
Guard against paternalistic tendencies.

Justice

Fair distribution of scarce resources.
Prudent adjudication of competing needs.
Coupling of rights and obligations.
May conflict with legislation.

Consequentialism

The morally correct action is the one that results in the best overall outcome, regardless of the means used.
Inherent rightness or wrongness of an action is not considered.
Utilitarianism is the most influential consequentialist theory.
The principle of utility states that the morally correct action is the one that promotes the greatest happiness for the greatest number.
Considers the consequences for present and future generations.
Considers both the consequences of action and inaction.
Considers unhappiness caused to calculate net happiness.
Weakness: Difficult to predict future consequences accurately.

Deontology/Kantianism

Deon=Greek for duty/obligation
Focuses on duties/rules rather than consequences.
Some actions are inherently wrong irrespective of consequences.
Kantianism considers duties to arise from rational human beings.
Kant's categorical imperative requires the application of moral duties universally: treat others as you would like to be treated.
Actions may ignore consequences or emotions and needs of a person.
Weakness: no list of duties, does not suggest what to be done if two duties collide, less stringent than consequentialism that constantly assesses the consequences of an action.

Virtue/Character Ethics

Introduced by Aristotle.
According to virtue theory, actions by a virtuous person lead to human flourishing.
Incorporate virtues in decision-making.
In a doctor-patient relationship, main virtues include: honesty, compassion, benevolence, discernment, integrity, and justice.
Strength and weakness of virtue theory is that the choice of virtues to apply in a situation is subjective.
A virtuous doctor should consider facts, their emotions, and the patient’s emotion to decide on the virtues to use to reach a moral decision.

Liberal Individualism

This is a rights-based theory, including positive and negative rights.
Rights are coupled with a responsibility such as compliance.
Water fluoridation may be viewed as an intervention devoid of individuals' autonomous choice, and hence not supported by this theory.
Rights may be limited by distributive justice, e.g. the individual right may end where public peril begins.

Communitarianism

Communitarianism is a community-based theory polarized with liberal individualism.
Needs of the community are ranked above those of an individual.
Rather than which rights have been infringed, the theory considers to what extent community best interests, values, and relationships have been impacted.

Ethics of Care

Focuses on the details of the people involved and their relationships.
It is skeptical of the abstract application of principles.
It overlaps with virtue ethics, communitarianism, and narrative ethics.
The question to be asked is: What would a caring person do if confronted by the problem?
Virtues a caring person would consider are: attentiveness, responsibilities, competence, responsiveness, etc.

Casuistry

The process of answering practical questions via interpretation of rules, or cases that illustrate such rules.
Method of applying theories that is more practical and easier to use in clinical practice.
Choice is made depending on decisions made earlier on similar cases.
A reflection of common law.
Weakness: junior doctors do not have adequate experience to use this principle.

Narrative Ethics

It involves taking account of those involved.
Has two essential elements:
- Use of cases as stories for their content.
- Analysis of stories for analytical and reflective learning.
Has a more substantial role than other theories in education of health professionals and solving medical dilemmas.
Every individual’s role in the story is examined and analyzed.
Each character is listened to determine beliefs and wishes.
But the patient's voice should be listened to first - patient's history.
Coupled with other principles as it does not offer clear guidance on ethical dilemmas.

Rights and Duties

There are different rights e.g. political, religious, and personal - the right to bodily integrity and to life.
Rights are also attached to groups in society.
There are moral rights and legal rights.
Negative rights: non-interference: not to be assaulted.
Positive rights: Impose a duty of support or assistance.
Only the person with the right can demand the duty be performed or can waive the right.
Few rights are absolute: right to life? Except in special circumstances.
Some rights may be in conflict: the right to life and to defence.

Ethical Decision-Making

Decision-making ranges from simple to complex.
Simple may just entail following golden rules.
Complex may require weighing principles and utilizing theories.
Decision-making involves judging and choosing.
Emotional state, incompetence, impairment, etc. affect the dentist's decision-making capacity.

Decision-Making Steps

Step 1: Problem: Identify the ethical problem: dilemma, weak morality, or moral uncertainty.
Step 2: Facts: Establish relevant information including dental, medical, legal, ethical, socio-political, patient’s preferences, dentist’s value system.
Step 3: Analyse: Considering facts gathered, weigh and rank values and ethical principles.

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Description

Explore the core principles of principlism in bioethics, focusing on autonomy, non-maleficence, beneficence, and justice. Understand how these principles guide healthcare decision-making and patient rights. This quiz assesses your knowledge of ethical considerations in medical contexts.