Our medical goal should be to provide the greatest benefit to the patient, an indication for immediate surgery. For example, consider a patient diagnosed with an acutely infected appendix. Yet, when two or more principles apply, we may find that they are in conflict. One might argue that we are required to take all of the above principles into account when they are applicable to the clinical case under consideration. The four principles referred to here are non-hierarchical, meaning no one principle routinely “trumps” another. Finally, medical benefits should be dispensed fairly, so that people with similar needs and in similar circumstances will be treated with fairness, an important concept in the light of scarce resources such as solid organs, bone marrow, expensive diagnostics, procedures and medications. Further, before implementing the medical care plan, it is now commonly accepted that the patient must be given an opportunity to make an informed choice about his or her care.
Or, the idea that the physician should develop a care plan designed to provide the most "benefit" to the patient in terms of other competing alternatives, seems both rational and self-evident. For example, the notion that the physician "ought not to harm" any patient is on its face convincing to most people.
Intuitively, principles in current usage in health care ethics seem to be of self-evident value and of clear application. How do principles "apply" to a certain case? Thus, in both clinical medicine and in scientific research it is generally held that these principles can be applied, even in unique circumstances, to provide guidance in discovering our moral duties within that situation. In that same year, three principles of respect for persons, beneficence, and justice were identified as guidelines for responsible research using human subjects in the Belmont Report (1979). However, specifically in regard to ethical decisions in medicine, in 1979 Tom Beauchamp and James Childress published the first edition of Principles of Biomedical Ethics, now in its seventh edition (2013), popularizing the use of principlism in efforts to resolve ethical issues in clinical medicine.
Similarly, considerations of respect for persons and for justice have been present in the development of societies from the earliest times. For example, in the 4th century BCE, Hippocrates, a physician-philosopher, directed physicians “to help and do no harm” (Epidemics, 1780). Some of the principles of medical ethics have been in use for centuries. Due to the many variables that exist in the context of clinical cases as well as the fact that in health care there are several ethical principles that seem to be applicable in many situations these principles are not considered absolutes, but serve as powerful action guides in clinical medicine. In the face of such diversity, where can we find moral action guides when there is confusion or conflict about what ought to be done? Such guidelines would need to be broadly acceptable among the religious and the nonreligious and for persons across many different cultures. Bioethics and Humanities, School of Medicine, University of WashingtonĮthical choices, both minor and major, confront us everyday in the provision of health care for persons with diverse values living in a pluralistic and multicultural society. McCormick, D.Min., Senior Lecturer Emeritus, Dept.
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