Overview
This lecture introduces four core bioethical principles—autonomy, beneficence, non-maleficence, and justice—and discusses their meanings, importance, and the challenges of applying them in healthcare decisions.
Major Bioethical Principles
- Autonomy: Respects individuals by allowing them to make important decisions about their own lives and healthcare whenever possible. For example, a competent adult should choose between palliative care and aggressive treatments for a fatal illness.
- Beneficence: Requires healthcare professionals to act in the best interest of the patient’s health. This includes ensuring that patients with serious illnesses receive necessary care, even if they cannot afford it.
- Non-maleficence: Obligates healthcare providers to avoid causing harm. Treatments should not be given if the likely harmful side effects outweigh the expected benefits.
- Justice: Calls for fairness and equity in distributing healthcare resources. Everyone should have access to decent healthcare, regardless of ability to pay, and new treatments or vaccines should be available to both poor and wealthy patients.
Application Challenges
- Applying these principles can be complex, especially when they conflict. For example, if a patient requests a procedure with risks that outweigh the benefits, a physician must balance respect for autonomy with the duty to avoid harm (non-maleficence).
- Striving to do what is best for each patient (beneficence) can conflict with justice, especially when resources like organs for transplantation are limited and cannot meet everyone’s needs.
- Justice raises difficult questions about how to allocate limited healthcare resources. Decisions must be made about what should be covered under universal health plans and how to prioritize spending between early-life care and end-of-life palliative or hospice care.
- There is debate about whether the relatively short duration of end-of-life care justifies fewer resources, or if the moral importance of how life ends requires greater investment.
Key Terms & Definitions
- Autonomy: The right of competent individuals to make their own healthcare decisions.
- Beneficence: The obligation to act in the best interest of the patient’s health.
- Non-maleficence: The duty to avoid causing harm to patients.
- Justice: The principle of fairness in distributing healthcare resources and ensuring equitable access to care.
Action Items / Next Steps
- Review and understand the definitions and implications of each bioethical principle.
- Consider and discuss scenarios where these principles may come into conflict, such as resource allocation or patient requests for risky procedures.
- Reflect on how to approach complex ethical questions in healthcare by starting with these core bioethical principles.