BIOETHICAL PRINCIPLES
and welfare of others, to assist others in their choices to live
A.      PRINCIPLE OF AUTONOMY
Personal liberty of action in which the individual determines
his/her own course of action in accordance with a plan chosen
by him/herself; self determination. Implies independence and
self-reliance, freedom of choice, and ability to make decisions.
Cannot exist in a vacuum but must be acknowledged and
respected by others.
B.      PRINCIPLE OF NON-MALEFICENCE
Do no harm. Includes:
* Deliberate harm - - always impermissible
* Risk of harm - - what degree of risk is permissible?
* Harm that occurs during performance of beneficial acts.
C.       PRINCIPLE OF BENEFICENCE
The duty to help others further their important and legitimate
interests when we can do so with minimal risk to ourselves.
Includes:
* The duty to confer benefits and actively to prevent and
remove harm.
* The duty to balance the good it is possible to produce against
the harm that might result from doing or not doing the good.
 D.      PRINCIPLE OF JUSTICE
The duty to give to the other what that person is due or owed,
what he/she deserves or can legitimately claim. Involves rights
or claims that must be balanced against each other.
 
1. Autonomy: Put most simply, autonomy affirms that we
ought to be the authors of our own fate, the captain of our
own ship. Autonomy emphasises the personal responsibility we
have for our own lives; the right to choose who we wish to be,
to make our own decisions and to control what is done to
ourselves. Autonomy includes the capacity to deliberate about
a proposed course of action as well as the ability to actualise or
carry it out.
2. Nonmaleficence: Nonmaleficence derives from one of the
most traditional of medical guidelines that goes back to the
time of the Hippocratic oath: First of all, do no harm. The
principle of nonmaleficence imposes the obligation not to harm
someone intentionally or directly. Clearly there are many
instances in the field of healthcare where individuals are
exposed to risks of harm, such as radiation or chemotherapy
treatment. The principle of nonmaleficence is not necessarily
violated if a proper balance of benefits exists; that is, if the
harm is not directly intended but is rather an unfortunate side
effect of attempts to improve a person's health or, at the very
least, to provide relief from the burden of pain.
3. Beneficence: Beneficence may be described as the positive
expression of nonmaleficence. This principle highlights that we
have a positive obligation to advance the healthcare interests
life to the fullest. Beauchamp and Childress have described
beneficence as a way of ensuring reciprocity in our
relationships; i.e. we have a responsibility to help others
because we have ourselves received benefits. The risk of harm
to oneself represents a legitimate limit to our obligation to be
beneficent.
4. Justice: In relation to healthcare, justice may be described as
the allocation of healthcare resources according to a just
standard. There are two basic types of justice. Comparative
justice involves balancing the competing claims of people for
the same health care resources. It is only necessary because of
the fact that health funding is not unlimited if there was plenty
of everything, there would be no need to allocate or prioritise
resources. In comparative justice what one receives is
determined by one's particular condition and needs.
Distributive justice, on the other hand, determines the
distribution of health care resources by a standard that is
independent of the claims of particular people. For this reason
it may also be called 'noncomparative' justice. Distribution is
determined according to principles rather than individual or
group need.
Common Good: The good of each individual is related to the
common good, that is the social well being and development of
the societies and the world in which we live. This is so because
we are interdependent beings our physical, social, emotional
and mental needs are fulfilled in and through our relationships
with others. It is therefore false to see individual rights as
somehow opposed to the common good (radical individualism
rejects the belief that the good of the community is a moral
value), although at times the common good does call for
arbitration between various competing interests. Due
consideration of the common good includes a respect for
human relationships within the whole of the created order. The
commitment to the common good calls for the co-operative
organisation of structures that enable access to what is needed
to live a truly human life: food, clothing, health, work,
education, culture, information, the right to have a family, and
so on.
Justice: A Catholic understanding of justice in healthcare begins
with the idea that medical care is a fundamental right, and that
essential services should be equally accessible to all. A health
system is unjust if the best services are available for those with
healthcare insurance, but people who lack wealth, status and
power can only access an inferior service (whether in terms of
promptness and/or expertise). With respect to healthcare
research it is also a fundamental tenet of justice that the
burden of risks be fairly distributed between various groupings.

In line with this, a Catholic approach to Bioethics is opposed to
the idea that distributions of health care services can be left up
to the marketplace or according to the ability of people to pay.
Therefore, what may be defined from a legal point of view as
being 'just' may not always be fair. Justice should ensure that
all persons, irrespective of wealth, power, status, religion or
affiliation, are treated in ways that accord with basic health
needs. Due care may, therefore, mean offering different types
of services to different groups of people. The commitment of
the New Zealand government to the Treaty principles of
participation, partnership and protection of Māori people in
the shaping and provision of health services for Māori, is a
good example of the application of the principle of justice in
healthcare delivery in New Zealand.
Conclusion: Rules and principles are essential 'tools' in the
process of decision-making. The four principles approach
provides a useful way of approaching dilemmas in bioethics. An
awareness of the limitations of the four principles reminds us
of the need to ground this approach within a broader
framework that allows for consideration of the deeper values
and attitudes which ultimately shape the way in which people
make use of the four principles. A Catholic-Christian
framework, among other things highlights the sacredness and
innate dignity of human life, upholds the need for truth,
recognises the importance of the common good, and highlights
the need for justice in a way that challenges us to make a
preferential commitment to the 'poor'.
Modern challenged parts of the oath:
1. To teach medicine to the sons of my teacher. In the
past, medical schools gave preferential consideration
to the children of physicians.
2. To practice and prescribe to the best of my ability for
the good of my patients, and to try to avoid harming
them. This beneficial intention is the purpose of the
physician. However, this item is still invoked in the
modern discussions of euthanasia
Euthanasia refers to the practice of ending a life in a
manner which relieves pain and suffering... and
controversial medical treatments such as aversion
therapy
Aversion therapy
Aversion therapy is a form of psychiatric, mental
health or psychological treatment in which the patient
is exposed to a stimulus while simultaneously being
subjected to some form of discomfort...
 and lobotomy
Lobotomy is a neurosurgical procedure, a form of
psychosurgery, also known as a leukotomy or
leucotomy . It consists of cutting the connections to
and from the prefrontal cortex, the anterior part of
the frontal lobes of the brain. 
3. I will not give a lethal drug to anyone if I am asked,
nor will I advise such a plan. Physician organizations in
most countries have strongly denounced physician
participation in legal executions. However, in a small
number of cases, most notably the U.S. states of
Oregon
Euthanasia
Euthanasia refers to the practice of ending a life in a
manner which relieves pain and suffering... with the
patient's consent.
4. Similarly, I will not give a woman a pessary to cause
an abortion. Since the legalization of abortion in many
countries, the inclusion of the anti-abortion sentence
of the Hippocratic oath has been a source of
contention.
5. To avoid violating the morals of my community. Many
licensing agencies will revoke a physician's license for
offending the morals of the community ("moral
turpitude
Moral turpitude
Moral turpitude is a legal concept in the United States
that refers to "conduct that is considered contrary to
community standards of justice, honesty or good
morals."..
6. I will not cut for stone, even for patients in whom the
disease is manifest; I will leave this operation to be
performed by practitioners, specialists in this art. The
"stones" referred to are kidney stone
7. To keep the good of the patient as the highest priority.
There may be other conflicting 'good purposes,' such
as community welfare, conserving economic
resources, supporting the criminal justice system, or
simply making money for the physician or his
employer that provide recurring challenges to
physicians.