CHAPTER 1

BASIC ETHICAL PRINCIPLES

The Value of Life Principle
The value of life principle underscores the value and inviolability of a person’s life irrespective of his social
status. Faced with a patients critical condition, for instance, the doctor/nurse should look after his welfare and
should administer to his medical needs, and should take steps to cure him. His/her duty to bring patient back to
good health as much as possible.

The value-of-principle of health care ethics also demands other related attitudes, such as: concern, and
solitude of health care professionals towards individuals under their care, like their deep concern for a patient’s
welfare, regardless of his station in life, rich or poor. The self-worth of a patient should not be measured by his
financial capability to pay his hospital bills but by his human dignity as a person. Whether one is affluent or
indigent that rightfully deserves equal medical treatment and attention.

The value of life principles is used as a moral argument against mercy killing and suicide. Life, it is argued,
is inviolable and sacred. Only God has complete control and dominion over life; our duty is to take good care of
it until God(who has loaned it to us) takes it back from us.

Moreover, in light of this principles, the Christian believer upholds that human life begins upon
conception; that is, as soon as the chromosomes from the sperm of the husband and the ovum of the wife fuse
together, then a human being exists that must be valued in the same way as if he/she were already born. Hence,
to manipulate or expel a newly fertilized ovum, or fetus, is to commit murder. This explains why pro-life
advocates are against stem cell research, which makes use of fetuses in medical experimentation.
Principle of Beneficence
Beneficence, means the practice of doing acts of kindness, goodness, and charity. The beneficence principle of
health care ethics may be thus stated: “Do not harm and produce good,” or “Do good and do no harm”. It prescribes
the avoidance and prevention of harm and the production of good. As much as possible, health care professionals
should take great care not to compound of aggravate the ill patient’s condition by causing further injury.

It is their obligation to keep people under their care from harm. This principle has two complimentary aspects: Its
positive aspect is the production of the good, and its negative aspect the avoidance of harm. Health care professionals
are enjoined not only to avoid what is harmful but to do whatever is good for the patient as well.

To cite some examples, this principle is used to justify surgical operations, such as appendectomy, hysterectomy,
mastectomy, and ovariotomy. In this cases, one is doing more good than harm to the patient. This explains why this is
also known as the principle of nonmaleficence, precisely because it stresses that harm or pain should not be inflicted
upon others.’

The cutting off, mutilation, or removal of any defective or worn out nonfunctioning part of the body (or to destroy
its capacity to function) is justified insofar as the general well-being of the whole body requires it.
Principle of Beneficence
Likewise, the advocates of new biomedical behavioral technologies appeal to this principle in advocating genetic
therapy and other laboratory-based methods of human reproduction. In case a fetus, for example, is detected to be
terribly malformed or defective through a process known as amniocentesis, would you be more good than harm by
aborting it? If you operate on an individual for an enlarged appendix, are you not inflicting injury and pain upon the
person? Will you not be doing him more than good?

These queries are pertinent to the beneficence principle insofar as it stresses that no harm or pain should be
inflicted upon others, regardless of their social or economic status in life, and irrespective of their religious beliefs or
party affliations.
Principle of Autonomy
Respecting a person’s autonomy when the person is capable of autonomous decision-making is a very important
principle of health care ethics. In Greek, auto means “one’s own,” and nomos stands for “rule, principle, or law.” Thus
autonomy would be “living or acting according to one’s own rule, principle, or law.” Autonomy will be taken here to
refer to a person’s choosing and acting on the basis of his/her own values, principle, or ideals of conduct, goals and
purposes.

Also known as the right self-determination, this principle is the central element in the relatively recent emphasis
on patient’s rights. It gives stress to the moral right of an individual to determine what is good for himself/herself and
for others. The principle marks the significance individual autonomy, which mandates a string sense of personal
responsibility.

Every individual is autonomous in which case one should choose what one wishes to be and should take
responsibility for that choice. Anyone who personally bears the burden of his/her moral decision (like the burden of
women pregnancy and childbearing) ought to make that decision. Only the individual who personally assumes the
burden of responsibility should make the decision.

Thus, the principle underscores individual freedom, giving centrality to the sovereignty of the individual freedom,
giving centrality to the sovereignty of the individual’s conscience, especially in cases of moral uncertainty. One’s
conscience is the last arbiter of moral decisions. In most circumtances, capable adults (or mentally competent patients)
are the best judges of what will maximize their own well-being.
Principle of Autonomy
And in as much as every person is autonomous, one should make moral decisions by and for oneself make moral
decisions by and for oneself. For example, once informed about the nature of his ailment as well as the respective
medical treatment (i.e., surgical or otherwise), a patient has to decide on whether to undergo it or not. Likewise, he has
to decide on whether or not to take part in a research after he has been properly and adequately informed about its
importance.

It is assumed that respecting someone’s autonomy yields satisfaction for that person directly, while interfering
with it yields a form of anxiety, pain or suffering. So, to maximize values and well-being, don’t interfere with capable
people’s choices. The limitations to one’s autonomy are explained at length under patient’s rights in Chapter 2.
Principle of Justice
Justice basically means the rendering of what is due or merited. For instance, one acts justly whenever one gives
others their due; but one acts unjustly whenever one with-holds what other deserve. In the medical context, a health
care professional ( be it a physician or a nurse) acts justly (or performs an act of justice) if and when the rights of the
patients are respected; on the other hand, an act of injustice is done(i.e., the health care professional acts unjustly)
whenever one’s duty to the patient is neglected.

In a nurse-patient relationship, therefore, justice is done if and when the nurse performs her/his duty as such to the
patient; otherwise injustice is committed insofar as the patient’s right to be attended to is not given what one deserves
as a patient, because the nurse fails to perform her duty as such.

In this sense, too, the nurse’s negligence or tacit nonperformance of her duty is not only unjust but wrong as well,
in as much as she fails to do what should be done in relation to the patient. (Take notice here the infraction committed
against the duty-right correlates in a nurse-patient relationship)

The principle of justice that interests health care professionals, however, is the equal distribution of harm and
benefits, of burdens and comforts, of goods and services among those who need them. It refers to a principle of equity,
which prescribes fairness and impartiality regarding equal access to health care and the allocation of scarce medical
resources between two individuals or to a group of persons who are in direct need of treatment.
Principle of Justice
Health care professionals speak of two types of justice in this regard, namely; comparative and
noncomparative justice. Comparative justice is one in which what an individual patient or a group receives is
determined by balancing the competing claims of other individuals or groups. That is to say, what a particular
patient receives is determine by the gravity of the condition or need.

Noncomparative justice, on the other hand, is one in which the distribution of medical goods or resources is
determined by a certain rather than by the needs or claims of individuals. In other words medical treatment is
determined by principle (rule or policy), not by need. A principle of treatment or a policy of distribution is
formulated which prescribes a strict numerical equality of treatment, irrespective of the needs of an individual.

A certain procedure or system to be followed in distributing treatment is thus made, especially if medical
resources are scarce or limited. To cope with the problem, a certain policy may be devised such as, “First come
first served”, “Senior citizen first”, “Pregnant women first”, and the like.
As health care professional, a nurse or doctor has been trained to care for the sick, injured, or inform with the
end–in-view of bringing them back to health. In this respect, health care service manifests the nurse’s feeling of
concern, which arises from his/her responsibility or affection for the patient. Now, in the performance of his/her duties
as such, there are basic ethical principles to be assumed