Basic Principles of Health Care and The Nature Type of Consent

of Rights in Ethical Discourse

❑ Admission agreement
Morality
❑ Immunization consent
❑ what is believed to be right and good.
❑ Blood transfusion
Ethics
❑ Surgical consent
❑ Generic term for the study of how we make
❑ Research consent
judgements in regard to be right and wrong.
❑ Special consent
❑ Offers a way of examining the moral life.
Autonomy vs. Paternalism
Professional Ethics
Paternalism is the international limitation of the
❑ Applied Ethics, designed to bring about
autonomy of one personal by another
ethical conduct.
➢ Therapeutic privilege
❑ Differing professional have different views
as to what constitute the end good or major • In case of emergency
purpose.
• Incompetence
❑ These views shape the application of the
basic ethical principles. • waiver

UNIVERSAL PRINCIPLES OF BIOMEDICAL ➢ Benevolent deception

ETHICS • Problematic Area
Hierarchy of Reasoning by Values Veracity
✓ Worldview ➢ Obligation to tell the truth
✓ Basic Principles
✓ Rules and Codes ➢ Health care provider can be of little
✓ Decisions assistance if patient lies.

Autonomy ➢ Patient cannot be autonomous if health care

provider lies.
- From the Greek autos (self) and nomos
(governance). Beneficence

▪ Individual’s right to make their own - Duty to do good to others.

decisions. - Every patient has the right to assume the health
▪ Respect for the autonomy of others care provider is actively seeking their good.

▪ Self -Determination ▪ One ought to prevent evil or harm

- Informed Consent ▪ One ought to remove evil or harm

▪ Which generally contain the elements of ▪ One out to do or promote good

disclosure, understanding, voluntariness,
competence, and permission giving.
Non-maleficence ❖ To each according to ability
- Stated as an admonition in the negative form Compensatory Justice
to remind health practitioner “First, do no
❖ In which individuals seek compensation for
harm” (primum non nocere).
wrong that have been done.
➢ One ought not to inflict evil or harm
❖ Retributive justice – an eye to an eye and a
Principle of Double Effect tooth for a tooth.
✓ The course chosen must be good or at least Role of Fidelity
morally neutral.
- Keeping one’s promises; loyalty.
✓ The good must not follow as a consequence
- Ethics of health care require that the practitioners
of the secondary harmful effects.
practice faithfully within the constraints of the role
✓ The harm must never be intended but merely
tolerated as casually connected with the
good intended. The Nature of Right
✓ The good must outweigh the harm. RIGHT - Described as entitlements, interests,
powers, claims, and needs.
Confidentiality
Ronand Dworkin “A right is something of which
- Is an important of the trust that patients
no one may be deprived without a grave affront to
place in health care professionals.
justice.”
- Is a central element of the therapeutic
“Rights can be thought of as trumps which take
relationship
precedence over mere expediency or social benefit.
- A great barrier between practitioner and
▪ Rights in moral philosophy and political
patient.
theory are of as justified.
Justice
▪ Rights can be justified by moral or legal
- Refers to the right to demand to be treated principles and rules, or in some cases a
justly, fairly and equally. claim to both moral and legal justification.
- We require procedural justice or due to ▪ It is very difficult to explicate the status of
process in cases of disputes between the rights claimed in them in the sense of
individuals. Correlative Obligations.
- In health care we can deal with distributive ▪ Recipient rights (Positive) imply a duty on
justice as we struggle with the distribution the part of others.
of scarce resources.
▪ Liberalism and Humanism, the dominant
Methods for Several the Distributions of Good philosophies of Western democracies,
and Services require human rights.
❖ To each an equal share Historical Background of Rights Reasoning
❖ To each according to need ▪ Natural Rights were generally equated to
the law of God and found their most
❖ To each according to effort
succinct expressions in forms such as
❖ To each according to contribution Golden Rule.

❖ To each according to merit

 ▪ Natural Liberties are universal moral rights The following are the key concepts drawn from
and are thought to exist prior to and the historical traditions of natural law:
independent of the guarantees of a social
➢ Humans possess a rational nature as a gift
contract or institutional government.
from God.
▪ The concepts that all men are “endowed by
➢ Natural laws are not dependent on social
their Creator with certain unalienable rights;
contract.
that among these are life, liberty and the
pursuit of happiness”. These are often called ➢ Natural laws are unchangeable and
negative rights in that obligate offers to universal.
interference.
➢ Inability to effect natural rights does not
▪ The right to liberty is really a statement of distinguish them.
a personal right to be free from interference
of the exercise of that right, such as ➢ Natural laws can be discovered even without
enslavement. knowledge of God.

▪ The expression of human right seems to be GOLDEN RULES

have been used first by the American • Islam - No one of you is a believer until he
Firebrand patriot Thomas Paine. desires for his brother than which he desired
▪ Positive Right – claims good or services. for himself. (Sunnah)

Thomas Aquinas (1225-1274) • Judaism - What is hateful to you, do not to

- States in the Treatise on Law : to all natural your fellow man. (Talmud)
law belong those things to which a man is • Buddhism - Hurt not others that which you
incline naturally; and among these it is would find hurtful. (Udana-Varga).
proper to man to be inclined to act according
to reason…Hence this is the first percept of • Brahmanism - Do naught unto others which
law that good is to be done and promoted; cause you pain if done to you.
and evil is to be avoided. (Mahabharata)
- Natural rights are basic truths that can be
• Confucianism - Do not unto others that
understood and known by human reason
which you would not have them do unto
alone and are not dependent on outside
you. (Analects)
dictates.
• Taoism - Regard your neighbor’s gain as
John Locke
your gain, and your neighbor’s loss as your
- Who wrote of self-evident principles whose own loss. (T’ai Shang Xan Ying P’ien)
veracity the “mind cannot doubt, as soon as
• Christianity - All things whatsoever ye
it understands the words.”
would that men should do to you, do ye even
- According to Locke, the “law of nature”
to them. (The Bible)
“teaches all mankind that, being all equal
and independent, no one ought to harm
another in his life, health, liberty, or
possessions.”
Contractarian and Consequentialist Fair Opportunity Rule
Rights Theory
The original position , neither choose to have
Jeremy Bentham slaves, if the choices were made from this original
position , the principle of justice would prevail , as
▪ Father of Utilitarianism
Rawls has removed the opportunity for either of the
▪ The concepts of natural rights, holding that individuals to exploit the determination to their
they are were “absurd in logic and advantage.
pernicious to morals.”
Contractarians believe the individual right are
John Stuart Mill grounded in the principle of justice and collective
choice , and it this collective choice that forms the
▪ Sets out the following in regard to right and basis of morality. Yet there are those who state that
wrong. Rawls in his setting up of original position has
▪ Describes as being the distinction between already posited the concept of a moral right to equal
morality and simple expediency is better. concern and respect. If this were true , then it would
seem that these right would need to have existed
Duties were subdivided into two sets: prior to the collective choice procedure.
Duties of Perfect Obligation LEGAL RIGHTS
- Which have inherent within them assigned ❖ A power privilege or immunity guaranteed
correlative rights. under a constitution, statues or decision law.
Duties of Imperfect Obligation ❖ Created through constitutional guarantees,
- Which do not give birth to any right. legislative status, judicial review, and
governmental agencies.
Contractarian Theory
❖ Negative Rights which require others or
✓ The driving force or mechanism for the refrain from interfering with our claims.
selection of correct principles.
❖ Positive or Welfare Rights which call for
Thomas Hobbes (1588-1679) provision of good and services.
✓ The most famous of the nonmoralized initial ▪ Only legal person can receive legal rights,
situations is the state of nature. the characteristics commonly attributed to a
✓ According hobbes, life in the state of nature legal person include that;
prior to formation of government was ➢ Persons can be injured
“solitary, poor, nasty, brutish and short.
➢ Persons can be though to have interests
John Rawls
➢ Persons can be benefited
➢ A more useful contractarian model for
development of justified claims for Note:
individual right is moralized initial situation. • Legal rights may or may not based on
➢ Original Position is designed to promote established moral claims.
rational choice and fairness. • Legal rights obviously differ by junction and
➢ All individuals are free and equal. nation.
• Legal rights are often used to reaffirm moral
right, they do not necessarily coincide.
 • In health care, we will argue our obligations ▪ right to guaranteed with Periodic paid
and duties regarding each other in the holidays.
language of rights.
Conclusion
Moral and Legal Rights
✓ Ethics is philosophy with systematic
➢ the rule’s and regulations that all approaches to questions of morality.
people are mandatory obligated to Its provides the intellectual
adhere. framework that allows us to analyze
and make decisions in regard o moral
➢ Moral rights are discovered not
choices.
created.
✓ Professional codes of ethics can be
➢ Legal rights are created by
seen as rules derived for the universal
legislation.
principles of autonomy, veracity,
➢ First, they are universal. beneficence, nonmaleficence, justice,
confidentiality, and role fidelity, to
➢ Second, moral rights provide bring about the goals of the
equality among humans. profession.
➢ Third, moral rights are believed not ✓ The English language is rich in rights
to be the product of human language, and nothing seems to
creativity. confer power on these basic claims to
➢ 1980, the people republic of China the same external as framing this
implemented a one child policy to a curb rights.
it’s surging population.
➢ 2015, government relaxed the policy and
now allows for two children per family
among the majority population China.
The Problems of Rights
One of the interesting but peculiar aspects of
humanity and our society is the multiplication of
claims to personal rights.
▪ People advocate a right to die
▪ A right to health care
▪ A right to smoke hemp productions
▪ Non smokers rights
▪ Animal rights
▪ Women rights
▪ Abortion rights
▪ A right to die
▪ A right to know
▪ A right not to know