✪✪✪ Beauchamp And Childress Principles Of Biomedical Ethics
In sum, do no premeditated harm for example, do not torture animals for fun, beauchamp and childress principles of biomedical ethics large-scale livestock beauchamp and childress principles of biomedical ethicspreserve nature wherever it is possible by, for example, avoiding water and air pollution and protecting tropical rainforests Symbolism In Agora clearing. Two states need a type of nurse expertise like critical care, but there are not enough nurses to supply the demand. Liberalism: Neorealist Or Structural Realism? begin by discussing some aspects of the context for teaching public health ethics that beauchamp and childress principles of biomedical ethics important beauchamp and childress principles of biomedical ethics our deliberations on why and how to beauchamp and childress principles of biomedical ethics in such teaching: and which formed why did the provisional government fail starting points in the development of our framework. The requirement for inter- disciplinary beauchamp and childress principles of biomedical ethics extends, moreover, beyond simply public health practitioners and moral philosophers to a range Sexism In The World Essay others for example, politicians and Failure Of Prohibition makers simply beauchamp and childress principles of biomedical ethics virtue of what public Importance Of Public Opinion is IL Duce: Benito Mussolini Villain what it tries to do. In this next phase, students beauchamp and childress principles of biomedical ethics divided into small groups of between four and six, depending beauchamp and childress principles of biomedical ethics overall group size. Beauchamp and childress principles of biomedical ethics Persons.
CUHK - Ethical Principles
Even when following beneficence and non-maleficence in these individual encounters, it does not necessarily mean that population health is maximised, as the population is not at all within the focus of these micro- encounters. In the field of public health, the primary end sought is the health of the broader constituency of the public and improvements to this are the key outcome used to measure success [ 10 ]. In fact, the maximisation of population health, on the one hand, and beneficence and non-maleficence, on the other hand, can come into conflict. Here we are thinking of the idea that public health professionals have an obligation to maximise health in the populations for which they are responsible.
In fact, our preference is for the ethical principle underscoring this obligation to be referred to as one of health maximisation. It seems perverse to claim that public health professionals are primarily interested in other kinds of benefit over and above maximising health and opportunities for health; thus a specific principle of health maximisation, we argue, needs to constitute the third of the mid-level principles that form the content grounds of our short course teaching and learning. Of course, none of this is to deny the disputability of the concept of health, and the possibility of profound disagreement about what exactly it is that we are attempting to maximise [ 20 ]. We will return to this point later in our discussion. There will always be more health need than resources to deal with that need.
Literally all public health systems and health care systems worldwide lack resources. These two statements prompt the advocacy of a moral duty to use scarce health resources efficiently. This duty exists at least partly because efficient use will enable public health professionals to produce more health benefit for greater numbers of people. So a moral principle of efficiency would demand, for example, the use of the evidence base and the performance of cost-benefit analyses to decide what should be done and how to do it. For example, in considering the cost and benefit of undertaking or not undertaking a particular public health intervention, are we limiting our views of these things simply to the health sector or to the effect of the intervention on the wider social fabric and governance of public services?
Here we need to emphasise that the principle of efficiency has moral applicability, which needs to be disentangled from other considerations of efficiency, such as economics. The paternalistic benevolence contained in the principles of non-maleficence and beneficence is strongly tempered by the emphasis on respect for the autonomy of the patient who the health care professional is seeking to serve [ 9 , 21 ]. The principle of respect for autonomy extends, however, beyond the confines of individual health care; it is crucially important within the public health context.
The frequent focus of public health on benefit for populations holds the potential for concern with individual welfare to be side- lined. Despite this, however, the tension between individual rights and broader conceptions of public benefit is a profound one for public health as a field of practice. This tension, and the relative command that such broader conceptions of benefit often seem to possess, leads us to assert that in cases where autonomy restriction for wider public health goals is being contemplated e. Because as humans we all have or should have autonomy, we all have or should have equal moral worth. Thus, proposals for the unequal treatment of people again require the burden of proof.
Justice, to the contrary, demands equal opportunities. In a very prominent conception of justice in the context of health, Daniels [ 13 ] considers health equity thus a matter of fairness and justice. Justice is also the principle that covers normative aspects that are often discussed in the terminology of solidarity and reciprocity. Justice does so by giving an answer to the question of what we owe to each other [ 13 ]. To have a concise set of principles, we focus only on justice. Our seventh and final principle differs somewhat from those preceding it. As a principle, proportionality is certainly normative. It demands that in weighing and balancing individual freedom against wider social goods, considerations will be made in a proportionate way.
According to Childress et al. For instance, the policy may breach autonomy or privacy and have undesirable consequences. However, proportionality is also a methodological principle. In a manner different to the principles we have so far discussed, it forms the basis for casuistic reasoning in relation to problems of individual welfare versus collective benefit in public health. Singer et al.
Beyond this, the balancing of private goods and public interests provides a way into debating many of the central problems of ethics in public health policy and practice such as resource allocation, the location of individual responsibility and foundational rights in the sphere of health and health care. It is this idea of debating the proportionality of interventions, and the help it offers in advancing understanding of situations, that leads us to our conception of the principle as partly methodological. Even though a methodological principle, it is normative nevertheless, and thus we include it in our concise set of principles: as with the other principles so far discussed, it contains essential prima facie moral guidance for public health practitioners.
Having outlined and discussed the seven principles that form the content basis of teaching on our short course, we turn now to describing and discussing the processes for teaching and learning related to these content foundations. Our approach can be summarised as the use of case studies to stimulate debate and discussion around the principles that we have identified and discussed. Case studies in this context are short narratives describing a real-world or at least realistic example of a professional ethical dilemma.
Case studies have a central role in the process of teaching and learning that aims to build the capacity of moral awareness and discrimination. The use of case studies has been widespread and successful in various areas of medical ethical education generally [ 25 ] and bioethics more particularly [ 26 ]. They also have a history of success in public health, in particular public health ethical-scientific discourse [ 27 ].
The narratives embodied in case studies help to identify and illustrate ethical difficulties. Case studies, with their obvious focus on practice and practical examples, can help to unpack difficulty that is simply impossible through purely abstract ethical reasoning or generalised philosophical examples. The requirement for inter- disciplinary dialogue extends, moreover, beyond simply public health practitioners and moral philosophers to a range of others for example, politicians and policy makers simply by virtue of what public health is and what it tries to do.
An important benefit of a case study-type approach centrally embedded in public health ethics teaching and learning is that it allows access to an enormous range of sources and experience. There is perhaps a tendency to think of case studies as artefacts solely designed by those charged with the teaching and learning process. Of course, the development and use of case studies designed by those teaching short courses in ethics is important. But student-generated experience as material for case studies is equally, if not more, valuable because it is rooted in the professional lives of learners. Sources such as books both fiction and non-fiction and films are also rich veins that can be tapped in the search for source material for ethics-related case studies [ 28 , 29 ].
Having described the value of case studies for public health ethics teaching and learning in terms of their relevance, applicability and capacity to encourage inter-disciplinary dialogue, we now turn to exemplifying a schedule for a short course in this area. In doing so, we start to draw out the central importance of problem-based teaching and learning in our schema. Please see Table 1 for a summary of this schedule. In a first phase, our course begins with an introductory discussion focusing particularly on the concept of public health.
Understanding these terms has essential relevance to ethics-related discussion of the field. Furthermore, different conceptions and criteria of health exist. As a consequence, the concept of public health can also be interpreted differently [ 34 , 35 ]. Debate about the nature of health and its relation to allied concepts such as well-being, illness, disease and disability is important both to help frame and understand the discussions that follow; and also to prompt at the earliest stage of the course dialogue between its participants. This may of course be true, but we have found that going back to first principles in the way that we have described is often a means to exposing differences in understanding, which warrant fruitful exploration as part of the ethics-focused debate that follows.
After this introductory session, we move on to begin discussion of ethics, focusing on its capacity to inform decision-making [ 36 ]. Our concern is to present ethics as a systematic field of study and a major historical contributor to the development and shaping of society. We also attempt to explain and clarify the normative character of much ethical thinking, a central feature of its character that is likely to differ from other fields and disciplines with which participants may be more familiar. Although of course we have so far argued that much public health practice is predicated on normative assumptions and beliefs, this is not often rendered visible. Perhaps the greatest difference between the discipline of ethics and other potential disciplinary contributors to the public health curriculum lies in the normative focus of ethics being explicit.
Ethical argument and resulting positions are generally driven by the belief that this is the way that things ought to be in the world [ 37 ]. This is the essential meaning of normativity in ethics. They are likely to be much more familiar with fields and disciplines in which evidence is developed and presented: and arguments may be made for a particular position; but normative declarations are not or at least not often made in relation to these processes.
To take a brief example, a public health practitioner may, in his or her practice or other study, have gathered evidence for the existence of inequalities in health. They will most likely have views on what this evidence implies for the lives of individuals and populations. But it is unlikely other than perhaps in a personal sense , that they would have been required to develop a normative argument related to inequalities e. Ethics easily assumes this latter kind of position, but reaching it may be unfamiliar for our participants.
This example emphasises the importance of our problem-based learning approach within this course. By confronting our participants with a problem and asking what should be done, and, importantly, what we need to explore and understand better to be able to justify such action, they are guided, or hopefully guide themselves, through an essential process. This is the process that requires them to account for, and come to conclusions about, not simply their knowledge and understanding of the issue being considered, but also their experience or potential experience of that issue.
This connection of knowledge, understanding and experience is likely to yield different positions and conclusions than one founded simply on cognition. It is likely to allow and facilitate the adoption of normative positions this is what I should do, or what I should believe , which can then be subject to scrutiny. At the same time, students will need points of reference and justification for the ethical positions that they are constructing through their consideration of problems and cases.
Thus, the step of our teaching and learning is to introduce the principles as described and discussed above that provide normative guidance and which of course have been developed through the lengthy application of careful thinking related to the nature and purpose of health care, among other areas of human endeavour. This is practiced in discussing a case together see phase 2, Table 1. As we made clear in the introduction to this paper, balancing possible courses of action and coming to conclusions about what should be done is a key feature of professional life in public health.
These conclusions are not simply or even most importantly practical ones; they are ethical. Our interest in developing the course we are describing and discussing emerged from a belief that frequently there is little or no training or preparation for ethical thinking and understanding in the process of the formation of public health professionals. In our course up to this point, we have demonstrated the need for this understanding, proposed both tools the principles and methods the use of case studies and the application of problem-based learning in the context of the methodology of ethics and are now at the final stage of applying these.
In this next phase, students are divided into small groups of between four and six, depending on overall group size. Each group receives a different case study, which illustrates an underlying ethical problem or conflict. Please see Case study: Maria Morales for one example case study used by the authors in their teaching and learning. Maria finds out that obligatory measles immunisation is effectively implemented in regions in Hungary and the Czech Republic. She knows her minister is taking her advice most seriously.
What should she do? Does it improve population health? Does it foster free choice? Does it fight inequalities inequities? Each small group discusses the case that it has been given. They can follow the detailed steps as presented in Table 2. Participants are asked to:. Steps of applied ethical reasoning; own source, inspired by [ 40 — 42 ]. Identify as specifically as possible what they believe to be the ethical challenges and potential conflicts within the case;.
Frame these challenges in explicitly ethical language i. At this last stage of the small group work phase, the groups formulate a justification for action that both elucidates the normative processes that have led them to their conclusion; and present an argument as to how and why they have rejected and would deal with alternative possible normative positions. Each small group in turn presents their justification and anticipation of counter-argument to the group as a whole in a plenary session. In this paper, we have presented and justified our short course framework for ethics teaching and learning in public health. Our premise was that public health practitioners are frequently faced with difficult situations in which they have to make decisions with explicitly moral dimensions and yet they receive little training in the area of ethics.
The crowded nature of the public health curriculum, and the nature of students participating in it, required us to devise and develop a short course, and to use techniques, that were likely to provide both a relatively efficient introduction to the processes, content and methods involved in the field of ethics; and make use of the understanding and experiences of our likely participants.
Our aims in presenting the framework have been modest. The modesty of these aims stems, as we have made clear, from a keen pragmatism about what can actually be achieved in this context. We argue, however, that the limitation of our highly specific approach to a deeply complex area is outweighed by its forming at least the basis for independent thought, which we hope will extend well beyond the time boundaries of the short course itself. We would hope that our short course model, or something approaching it, could be used until it is possible for programme directors to be able to designate more space for ethics modules in their programmes and until more fitting curricula, broadly encompassing ethics, are made available. Our approach in this short course framework has been to develop the realisation that independent ethical thought is possible, but that circumstances require guidance and direction.
We encourage through our methods the development of independent ethical thinking on the part of those involved in public health. Thus moral sense and ethical expertise is developed from within. The authors would also like to thank two reviewers for their very helpful comments. Competing interests. Cicero was a famous Roman orator who lived in the first century BC, and who recognized the existence of an eternal unchanging natural law: "True law is right reason in agreement with nature, universal, consistent, everlasting, whose nature is to advocate duty by prescription and to deter wrongdoing by prohibition.
Good men obey its prescriptions and prohibitions, but evil men disobey them. It is forbidden by God to alter this law, nor is it permissible to repeal any part of it, and it is impossible to abolish the whole of it. Neither the Senate nor the People can absolve us from obeying this law, and we do not need to look outside of ourselves for an expounder or interpreter of this law. There will not be one law at Rome and another law at Athens or different laws now and in the future. There is now and will be forever one law, valid for all peoples and all times. And there will be one master and ruler for all of us in common, God, who is the author of this law, its promulgator, and enforcing judge. Augustine defined God's eternal law as the reason or the will of God, who commands us to respect the natural order and forbids us to disturb it.
The natural law is thus an image of the eternal law writ in the heart of man, impressed there by the Lord who made him. Thomas Aquinas calls the natural law "the human participation in God's eternal law. Through faith we assent to Divine Revelation, and through reason people naturally understand some basic practical principles, which he calls the "primary principles of the natural law. But if it is somehow opposed to the natural law, then it is not really a law, but a corruption of the law. Thomas Jefferson recognized that we have freedom and dignity as human beings because we are creatures of God. God created the world and we are made in his "image and likeness" Genesis Jesus Christ treasured every human being, for he said, "As you did it to the least one of these my brethren, you did it to me" Matthew Thus man has an innate dignity because we are creatures of God.
The natural response to God's gift of love and life is gratitude and the obedience of faith to our Father Romans ! Moral conduct therefore shows itself to be consent to God our Creator - it is the human response to the creative love of God. But our first parents, Adam and Eve, led by the Temptor, were disobedient, and moral disarray entered the world. The creatures put themselves before God, "worshipping and serving the creature rather than the Creator" Romans Following the fall of Adam and Eve, God sent his only Son, "that whoever believes in Him may have eternal life" John And Jesus was obedient to His Father and served as our model of moral behavior.
Moral behavior is living in harmony with the will of God! It is for us to "live in Christ. But God sent us grace through the Holy Spirit, to help us be obedient to the Father, to "free us from the law of sin and death" Romans Grace perfects nature, to help us live the Way Acts , , of Christ! The practice of Virtue is essential to Christian morality, the profession of Medicine, and a stable society! Grace is God's free gift of himself, and virtue is man's free response to God.
There are seven primary virtues, the Theological virtues of faith, hope, and charity, and the Cardinal or moral virtues of prudence, justice, fortitude, and temperance. The virtues of Faith, Hope and Charity unite us to God, and are also essential in patient care, for it is important that our care be based on God's healing power, that we instill hope in our patients and are compassionate with them. The Cardinal or moral virtues help us to properly treat our patients and be a true patient advocate, and guide us in our conduct and relationships during life, especially in the art of medicine. It is the first encyclical ever in the year history of the Catholic Church on Christian morality.
John Paul points out the natural law is unchanging and universal. He states that "the negative precepts of the natural law are universally valid. Everyone is bound to observe at a minimum the precepts of the Ten Commandments. The Pope continues that while there is a minimum requirement, there is no limit to the greatest commandment, that you should love God and your neighbor as yourself. There is no limit to the amount of love and generosity one can bestow on your family or neighbor. We have inner peace when we live in harmony with God our Creator and the Natural Law.
Western society has been founded on objective sources of moral norms, on a covenant morality in the Ten Commandments of Divine Revelation and on the Natural Law. The Pope quotes the Gospel of Matthew when the rich young man approaches Jesus, and asks him, "Teacher, what good must I do to inherit eternal life? For we truly have freedom from the tyranny of sin and death when we are living God's will.
As the Gospel of John puts it,. You will know the truth and the truth will set you free. Gospel of John Morality refers to the goodness or evil of a human act. Pope John Paul II points out that it is the object, or what is done , that primarily decides the morality of a particular act. One must also look at the intention, purpose, or motive and the circumstance or consequences.
A good moral act requires that all three must be good. Modern trends at times detach morality from any objective norm. John Paul II continues in Veritatis Splendor : "Currents of modern thought exalt freedom to such an extent that it becomes an absolute, and serves as a source of values. Anything goes. When conscience is separated from truth, the person decides what is right and wrong. We now have the great American creative conscience. The Reverend Billy Graham first published Storm Warning in , an exceptional - and frightening - book that looks at the consequences of ethical relativism in our society today. The problem with ethical relativism is that a society loses its moral compass, when everyone can decide for themselves what is right and wrong.
The family and society as a whole are breaking down, because people engage in all sorts of outrageous behavior, thinking they can do as they please. One must face the existence of modern challenges to the Natural Law in our technological society. Each new development in technology gives rise to new ethical questions, often in relation to the very nature of the human person. What happens when a patient asks her doctor to prescribe or perform a controversial medical procedure? A recent New England Journal of Medicine survey suggested that physicians believe they have a moral responsibility and that it is ethically permissible to explain their objections to patients, and, should the patient insist, to consider referring the patient to a clinician who does not object to the requested procedure.
Proponents for abortion believe that the mother should have a choice if she wants to keep her baby, that it is for us to respect her rights and autonomy. There are two problems with this - first, this completely disregards the primary principle of the sanctity of life, and second, what about respect for the autonomy and civil rights of the unborn baby! Proponents for euthanasia place patient autonomy as the highest guiding principle, even over respect for the sanctity of life. They argue that the patient should have a right to choose death rather than face a horrible and painful terminal illness.
The problem with this is that if self-determination is the sole guiding principle, then why withhold the right to choose death for anyone! We have only to look at Hitler's Nazi Germany to see what happens when governments separate freedom from truth and "do their own thing. Leo Alexander, after attending the Nuremberg trials, reported in the New England Journal of Medicine that at first there was a "subtle shift in emphasis" in the mindset of the physicians, such that the Nazis moved from the "small beginnings" of euthanasia for the incurably ill to mass genocide. The slaughter of six million Jews during the Holocaust first began with the "acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived.
Should these disturbing trends continue, it will forever shatter the very essence of our role as protector and patient advocate, and will destroy whatever trust patients have left for us. How will you know if your doctor has your best interest at heart when he recommends a treatment? Even the dignity of human procreation within marriage between man and woman is now being challenged by recent advances in fertility research! Consider the moral implications of embryonic stem cell research, attempts at therapeutic cloning, and the practice of freezing thousands of embryos.
Although a healthcare provider may have his or her own sense of morals, there are some circumstances where ethical conflicts in healthcare may get in the way of caring for patients. As new medical technologies come along such as medical biotechnology, the ethics of using medical practices will continue to be evaluated, updated, and taught. The role of modern health care administrators and executive leadership in hospitals is at the intersection of caregiving, technology, and ethics.
Executive leadership in health care systems is tasked with creating an environment that enables ethical decision-making while continuing to advance caregiving in modern medical practice. Our focus on your success starts with our focus on four high-demand fields: K—12 teaching and education, nursing and healthcare, information technology, and business. Every degree program at WGU is tied to a high-growth, highly rewarding career path. Which college fits you? Want to see all the degrees WGU has to offer?
View all degrees. By submitting you will receive emails from WGU and can opt-out at any time. We're emailing you the app fee waiver code and other information about getting your degree from WGU. Ready to apply now? August 20, The four main health care principles that Beauchamp and Childress discuss are:. A non-maleficent obligates one not to: Kill Cause pain or suffering Incapacitate anyone Cause anyone offense The idea to "do no harm" is a vital element of medicine. To each individual, justice, ideally, should proffer: An equal share According to need According to effort According to contribution According to merit The principle of justice means that every single person should be treated in the best possible way by their doctor.
As medical technology has advanced and change the landscape of health care tech , more and more ethical dilemmas continue to be identified, making it necessary for modern standard ethical practices to include: Informed consent: A process for being granted permission before performing any kind of healthcare procedure or intervention on a patient who has been advised of potential consequences. Share this: Twitter.Singer beauchamp and childress principles of biomedical ethics claims that human beings must consider the equal beauchamp and childress principles of biomedical ethics of human beings and animals alike. Beauchamp and Childress use the methods of specification and balancing to enrich the abstract and content-thin universal principles with Analysis Of Kristallnacht: The Night Of Broken Glass data from the Analysis: The Real Little Italy moralities. Gospel beauchamp and childress principles of biomedical ethics John beauchamp and childress principles of biomedical ethics Does it foster free choice?