Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles

Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles

• Ethical Theories and
• Principles in Medical Practice

Learning Objectives

• Define common terms related to ethical theories and principles in
• medical practice
• Identify major ethical theories in medical practices
• Identify the importance of systematic study of ethics to medicine
• Identify the ethical principles in medical practice
• Analyze ethical principles in medical practice
• Apply ethical principles when managing patients/clients
• Definition of Terms
• Ethics
• Virtue
• Ethics:
• A systematic study of what a persons’ conduct and actions ought to be with
• regard to himself or herself, other human beings and the environment.
• The word ethics originated from the Greek word ‘ethos’ meaning customs or
• character.
• It is concerned with judgement about what is right or wrong conduct.
• Virtue:
• Moral excellence, goodness and rightness.
• It is also defined as conformity of one’s life and conduct to moral and ethical

principles, uprightness, and rectitude

Virtue Ethics

• Refers to a virtue of character as a health practitioner rather
• than rules governing conduct or consequences of any action
• by a health practitioner.
• Virtue ethics demands the practitioner to exercise loyalty,
• devotion and trustworthiness, good temperament,
• compassion and integrity.
• Virtue ethics is a philosophy developed by Aristotle and other
• ancient Greeks. It is the quest to understand and live a life of moral
• character. This character-based approach to morality assumes that we
• acquire virtue through practice.
• Bioethics:
• A system of standards arising from the professional agreement to
• determine, sanction, and justify the interaction of biomedical
• professional and patient.
• Bioethics is the study of ethical, social, and legal issues that arise
• in biomedicine and biomedical research.
• Bioethics is both a field of study and professional practice,
• interested in ethical issues related to health, including those

emerging from advances in biology, medicine, and technologies.

Ethical Principle

• Is a basic concept by which behaviour can be judged. Ethical
• Principles help people to make decisions, because they serve as a
• standard with which to measure actions.
• Governing rules of conduct, as code of conduct by which life and
• action can be directed, or as generalization that provide a basis for
• reasoning
• A principle is an established rule of action to be followed in
• implementing a set of activities
• Values
• Is something of worth or excellence or that which is esteemed,
• prized, or highly regarded.
• Values refer to one’s evaluative judgement about what one believes
• is good or what makes something desirable.
• Values are individual beliefs that motivate people to act one way or

another. They serve as a guide for human behavior.

Ethical Theories

• Consequentialism or Utilitarianism
• This is a moral theory that holds that an action is judged as good or
• as bad in relation to the consequence, outcome or end result that is
• derived from it.
• According to the utilitarianism school of thought, right action is that
• which has great utility or usefulness. Utilitarianism holds that the only
• factors that make actions good or bad are the outcomes, or end
• results, that are derived from them.
• Consequentialism is an ethical theory that judges whether or not
• something is right by what its consequences are.
• Utilitarianism is an ethical theory that determines right from wrong
• by focusing on outcomes. It is a form of consequentialism.
• Non-Consequentialism or Deontological Ethics
• Deontological theories of ethics are based upon rationalistic view
• that rightness or wrongness of an act depends upon nature of the act
• rather than its consequences.
• The term is taken from the Geek word for duty.
• For example, a man needs money to feed his family. He knows that he will
• not be able to repay it but sees that nothing will be lent to him if he does not
• promise to repay it at a certain time.
• Deontological ethics advocates against giving wrong promises disregarding
• the outcome of the wrong promise, hence this man should not give the
• wrong promise.
• The most famous version of non-consequentialism is deontology,
• which holds that one has an absolute duty to obey certain rules.
• “Never kill an innocent person” or “never lie” are examples of such
• rules.
• Deontology is an ethical theory that uses rules to distinguish right

from wrong. Deontology is often associated with philosopher

Immanuel Kant.

• Importance of Systematic Study of Ethics to Medicine
• Helps in understanding the origin and process of ethical and moral
• thinking.
• Enables health care workers to recognize situations with ethical and
• moral implications and make coherent and logical ethical decisions
• based upon recognized ethical principles and theories.
• Equips medical practitioners with knowledge necessary for making
• right decisions in issues and situations that have element of ethical or
• moral uncertainty and dilemma.
• Types of Ethical Principles
• There are five types of ethical principles:
• The value of life principle
• The principle of goodness or rightness
• The principle of justice or fairness
• The principle of truth telling or honesty
• The principle of individual freedom
• The Value of Life Principle
• This principle requires the medical practitioner to value human life
• and honour the patients’/clients’ wishes regarding quality of life.
• It demands to recognize life as basic and important, but also life
• should be recognized as having an end. Yet no life should be ended
• without strong justification such as in the situation whereby life of a
• pregnant woman is threatened by the presence of the fetus.
• In addition, when a medical practitioner becomes negligent, he
• threatens the life of the patient; when life of a patient is valued, a
• medical practitioner will not ignore any instruction on patient’s care.
• This explains why individuals should never be treated as mere means
• of achieving your objective, but always as a unique individual who will
• benefit from the results.
• When medical practitioner takes part in unethical activities such as
• abortion, euthanasia or suicide they infringe upon this principle.
• The Principle of Goodness or Rightness
• This principle demands that human beings attempt to do three
• things:
• Promote goodness over badness (evil) and do good (beneficence)
• Cause no harm or badness (non-maleficence)
• Prevent badness or harm (non-maleficence)
• Goodness or Rightness
• Individuals and societies, groups and cultures have different values
• and ideas of what ‘good’ implies.
• Certain things, however, seem to be generally recognizable as good.
• Examples of these things are life, pleasure, happiness, truth,
• knowledge, beauty, love, friendship, self expression, freedom, peace,
• honour and security.
• Goodness or Rightness cntd
• A medical practitioner is obliged to avoid harm or injury/hurt to the
• patients/clients in all aspects by demonstrating high level of
• competence in her/his practices.
• This principle provides justification for condemning any act that
• unjustly injures a person or causes them to suffer an avoidable harm.
• The Principle of Justice and Fairness
• Issues of justice are increasingly important in health care where
• dwindling resources force us to make choices that are (or appear to
• be) not just.
• The little resources available have to be shared fairly.
• Distribution of resources should be done without being influenced by
• the socio-economic position of clients, race, religion or gender.
• The Principle of Justice and Fairness
• cntd
• A health practitioner who adheres to this principle has the
• opportunity to utilize the available resources adequately
• Therefore the health practitioner minimizes unnecessary complaints
• from customers, conflicts within working area and creates a sense of
• commitment and good relationship among staff for the benefits of
• the patient/client and the organization.
• The Principle of Justice and Fairness
• cntd
• One way that health practitioners exercise their responsibilities for
• allocation of resources is by avoiding wasteful and inefficient practice
• even when the patient requests for them. Examples of resource
• allocation include:
• Staff duty allocation
• Use of time
• Distribution of resources such as consultation rooms, examination gloves,
• stethoscopes and BP machines
• In dealing with these allocation issues health practitioners must not
• only balance principles of compassion and justice but also which
• approaches to justice are preferable. These approaches include:
• Utilitarian- Resources should be distributed according to the principle of
• maximum benefit for all
• Egalitarian- Resources should be distributed strictly according to the need
• Restorative-Resources should be distributed so as to favour the historically
• disadvantaged
• Libertarian- Resources should be distributed according to market principles
• (individual choice conditioned by ability and willingness to pay, with limited

charity care for the destitute)

Case Study

• You are the in-charge of a health centre where resources are limited
• and you have few in store. Most of the patients are in a bed without
• bed sheets. On the same day you receive a seriously ill patient who is
• the daughter of the council chairperson. You decide to provide this
• patient with a new bed sheet from the store and you allocate one
• nurse to ensure the wellbeing of this patient.
• What do you think about this practice?
• Is it fair? Explain.
• What can be done to ensure justice and fairness in a situation like
• this?

The Principle of Truth Telling and

Honesty (Veracity)

• This is very important for the relationship with clients and colleagues.
• Without truth telling, society would not function properly.
• We go to hospital because we are sure that we shall get treated, and
• not otherwise.
• Truth does not merely mean giving information in health care.
• It means adequate and right information in order for the patient to
• make a decision
• Patients and clients have to rely on professionals to give them
• information necessary to make their own decisions.
• Medical practitioners share their knowledge and skills with patients
• and clients, rather than impose on them, so that patients and clients
• can take responsibility for their own care and well-being.
• Activity
• A patient came to hospital with uterine fibroid, and the doctor
• promised to remove the fibroid and leave the uterus intact. However,
• in the process of the operation, he did total hysterectomy without
• informing the patient. Two years later, the patient learned at the
• infertility clinic that her uterus was removed and she can never get
• pregnant.
• What are the challenges in this situation
• The Principle of Individual Freedom
• (Autonomy)
• This principle is also called the principle of autonomy and it enables a
• client/patient in making any choice as he/she wishes.
• Sometimes freedom is restricted in the interest of the public.
• In general, health care providers are required to obtain consent
• because they respect an individual’s right to freedom.
• An individual has the freedom to make choices about issues that
• affect him/her.
• The concept of autonomy involves respect, the ability to determine
• personal goals, the capacity to decide on a plan of action, and the
• freedom to act on the choice which has been made.
• It involves consent, which is a process whereby patients are informed
• of possible outcomes, possible alternatives and risks of their
• treatment.
• Managing clients without consent will result in non-compliance.
• Autonomy also values patient’s advance directives.
• In some situations, not all patients are competent to make decisions
• themselves.
• Examples include young children, individuals affected
• and mental health conditions and those who are temporarily unconscious.
• These patients require substitute decision-makers, usually a next of kin or

significant others.

Case Study

• A 15-year-old girl comes to the Reproductive and Child Health Clinic
• (RCH) where you are working and she requests an oral contraceptive.
• The next day her mother confronted you for giving her daughter oral
• contraceptive without her consent
• Questions
• What is your opinion concerning the reaction of that mother?
• Do you think it was ethically proper for the health worker to offer

contraceptives?

Other Ethical Principles

• A set of other ethical principles often cited in medical texts are those
• described by Beuchamp and Childress (1994) in their book; ‘Principles
• of Biomedical Ethics’.
• They are so well known that they have been called ‘The Georgetown
• Mantra’ as the authors were from Georgetown University. These
• include the following:
• The principle of respect for autonomy – meaning state of self governance
• The principle of non-maleficence – meaning not doing harm to others
• The principle of beneficence – meaning charitable or generous (promote the
• wellbeing of others)
• The principle of justice – meaning being fair in resource allocation and

fairness

Key Points

• There are five types of ethical principles that are important in
• providing quality care:
• The value of life principle
• The principle of goodness or rightness
• The principle of justice or fairness
• The principle of truth telling or honesty
• The principle of individual freedom
• Evaluation
• Define common terms related to ethical theories and principles.
• List two major ethical theories.
• Identify the importance of systematic study of ethics to medicine.
• 76 References
• • Beuchamp and Childress. (1994). Principles of Biomedical Ethics. Oxford: Oxford

University Press.

• Burkhardt, Margareth A., and Nathaniel, A.K. (2007). Ethics and Issues in
• Contemporary Nursing (3rd ed.). New York: Thomson.
• CIOMS. (1993). International Ethics Guidelines for Biomedical Research Involving
• Human Subjects. Geneva: Council for International Organizations of Medical
• Sciences.
• Furrow, Dwight (2005). Ethics: Key Concepts in Philosophy. New York: Continuum.
• Mellish, J.M. and Paton, Frieda, (1999). An Introduction to the Ethics of Nursing.

Capetown: Heinemenn.

• The Tanzania Medical Practitioners and Dentist Ordinance.
• Williams, John R. (1942). Medical Ethics Manual. World Medical Association, Inc.