MEDICAL ETHICS:

Four Principles plus Attention to Scope

Raanan Gillon
!
!

Bioethics
Jake Monaghan

University at Buffalo
9/3/14 & 9/5/14
1

A CULTURALLY NEUTRAL
APPROACH

prima facie: on first glance

ethics v. morality

these terms are used differently by different

philosophers

for our purposes, they are interchangeable

utilizes common moral commitments to four moral

principles

whatever our personal philosophy, politics,

religion, moral theory, or life stance, we will
find no difficulty in committing ourselves to
four prima facie moral principles plus a
reflective concern about their scope of
application. Moreover, these four
principlesencompass most of the moral
issues that arise in health care. (Gillon, p.
184)

PLURALISM

theories of value which think that the good reduces

to one thing are monist theories

theories of value which think that the good is made

up of many things are pluralist theories

Gillon cites the famous pluralist WD Ross and uses a

method similar to his in her essay

Pluralism gives rise to genuine moral dilemmas,

whereas monism does not

RESPECT FOR AUTONOMY

autonomy: rational/deliberative self-rule

according to some philosophers, autonomy is

the distinguishing feature of moral agents

respect for autonomy requires us to respect the

wishes of others to the extent that doing so
does not violate the rights of others

KANTS CATEGORICAL IMPERATIVE

One formulation: Act only according to that maxim

whereby you can, at the same time, will that it should
become a universal law

Another: Act in such a way that you treat humanity,

whether in your own person or in the person of any
other, never merely as a means to an end, but always
at the same time as an end.

Compare to the golden rule: Treat others as you

would like to be treated

IMPLICATIONS IN MEDECINE

respect for autonomy requires:

that patients give informed consent

respect for privacy (doctor-patient confidentiality)

that we do not deceive one another

that we determine whether patients want more or

less information, and whether they want a role in
choosing treatment options

CASE STUDIES IN AUTONOMY

A Christian Scientist (a member of the religion) does

not want to have his child receive medical treatment,
instead opting positive prayer alone

A mentally ill person wishes to end her life, despite

being otherwise healthy and capable of a life worth
living

A Jehovahs witness needs a blood transfusion in

order to survive a car accident, but refuses it due to
her interpretation of certain passages in the Bible

BENEFICENCE

duty to help duty not to harm; thus, two

principles

duty to help = principle of beneficence

NON-MALEFICENCE

duty not to harm= principle of non-maleficence

NET BENEFIT

Hippocratic oath = beneficence + non-maleficence

providing a net benefit requires respecting autonomy

requires knowledge of probabilities associated with

treatment

thus medical research is an obligation

empowerment = respect for autonomy + beneficence

+ non-maleficence

CASE STUDIES & HARM

woman with breast cancer needs a mastectomy

to survive

conjoined twins want to be separated, but the

surgery is more likely to result in the death of
both; the twins feel like a life conjoined is worth
living

JUSTICE

is not mere equality; as Aristotle noted, two

individuals can be treated equally and unjustly

3 subdivisons:

distributive justice

rights based justice

legal justice

PERSONAL DECISION MAKING

distributive justice:

rights based justice:

legal justice:

ORGANIZATIONAL, PROFESSIONAL,
& SOCIETAL DECISIONS

distributive justice

rights based justice

legal justice

CASE STUDIES & JUSTICE

A frequent cannabis smoker becomes ill as a

result of smoking cannabis with toxic levels of
fertilizer and insecticide. You, the doctor, think
that it is immoral to smoke cannabis. Must you
treat him?

A terminally ill ALS patient wishes to end her life.

It is illegal to help patients commit suicide where
you practice medicine. Although it is clearly the
right thing to do (you think), must you help her?

SCOPE

Gillon: This shit is hard!

SCOPE FOR HEALTH CARE

WORKERS

the answers are less ambiguous for individual

health care workers

Scope of duty of beneficence is rather obvious

in the health care context:

extends to your patients

SCOPE OF AUTONOMY

respect for autonomy extends to autonomous

agents (although determining the boundaries
of autonomous agents is tricky)

there is a spectrum of autonomy; this can

correspond to a spectrum of respect for
autonomy

Less Autonomous
Less Serious Decisions

More Autonomous
More Serious Decisions

SCOPE OF RIGHT TO LIFE

The right not to be (unjustly) killed vs. the right

to be kept alive

scope of the former extends to all persons;

does it extend further?

scope of the latter extends to your patients

(*maybe; this rests on a moral distinction
between killing and letting die*)

SCOPE CASE STUDIES

GILLONS CONCLUSION

the four principles + scope approach is not a

decision making procedure

Nonetheless, this works pretty well!

Shut up Socrates!