health ethics 2

Gambella University
College of Natural and Computational

Science
Department of Public Health
Health ethics and legal medicine for public
health students
By: Gemechu (MPH)
12/10/2024 1
Ethical Principles
Four fundamental ethical

principles are:-
 Autonomy
 Beneficence
 Non- maleficence
 Justice
12/10/2024 2
Ethical principles
cont’d…
Autonomy
• The word autonomy comes from two Greek

words: “autos” (self) and “nomos” ( rule);
meaning “ self- rule” or “self-
governance”
• Autonomy is the promotion of independent
choice, self-determination and freedom
of action.
12/10/2024 3
Autonomy cont’d…
Autonomy implies to an individual

who master of himself/herself:-
– can act,
– make free choices and
– take decisions without the

constraint of another.
12/10/2024 4
The term autonomy suggests four basic
elements:-
• The autonomous person:-
• is respected
• must be able to determine personal goals
• has the capacity to decide on a plan of action

• has the freedom to act upon the choices
12/10/2024 5
• The application starts with the respect

for a person’s right by providing them
with adequate and relevant
information.
• The application of this principle is seen
in the informed consent process.
12/10/2024 6
• Pre- conditions of autonomy are:
 competence and liberty or freedom
• Individual autonomy may be diminished or

completely absent as in the case of:-
 minor children
 mentally handicapped or incapacitated

persons,
 prisoners, etc.
12/10/2024 7
• Personal autonomy and freedom are

ethically limited by the autonomy
and freedom of other persons;
this is why in every society
discussion, compromise,
legislation is crucial.
12/10/2024 8
Models of autonomy
Charles, Gafni and Whelan identify

four models of autonomy
I. Paternalistic model
II. Informed decision making model
III. Professional agent model
IV. Shared decision making model

12/10/2024 9
Models of autonomy
cont’d…
I. Paternalistic model
 the provider makes all decisions on behalf of the
patient because the provider is considered to be
better informed.
II. Informed decision making model
 imposes the need for information dissemination
on the provider and the responsibility for
decision- making on the patient.
12/10/2024 10
Models of autonomy cont’d…
III. Professional agent model
 the patient willingly forego the right to
decision-making by voluntarily and explicitly
transferring the decision making task to the
provider.
IV. Shared decision making model

 focus on the sharing of both information and
decision- making between the patient and the
provider.
12/10/2024 11
Models of autonomy
cont’d…
Even though these models are clearly
demarcated in theory, in reality many
providers – patient relationships
are a combinations of these different
approaches, varying by disease,
patient profile and interpersonal
dynamics.
12/10/2024 12
Autonomy of clients is more

discussed in terms of larger issues
such as:-
• informed consent,
• paternalism,
• Non-compliance
12/10/2024 13
• Informed consent: is a process by which
patients are informed of the possible outcomes,
alternatives and risks of treatments and are
required to give their consent freely.
• It assures the legal protection of a patient’s
right to personal autonomy in regard to specific
treatments and procedures.
12/10/2024 14
• Paternalism: Restricting others autonomy to
protect from perceived or anticipated harm.
• Intentional limitation of another’s autonomy

justified by the needs of another.
• Thus, the prevention of any evil or harm is

greater than any potential evils caused by the
interference of the individual’s autonomy or
liberty.
12/10/2024 15
• Paternalism is appropriate when the

patient is judged to be incompetent
or to have diminished decision-
making capacity.
12/10/2024 16
• Non-compliance: Unwillingness of the

patient to participate in health care
activities.
• Lack of participation in a regimen that
has been planned by the health care
professionals to be carried out by the
client
12/10/2024 17
 Noncompliance may result from two factors:
– When plans seem unreasonable to the patient

– Patients may be unable to comply with plans
for a variety of reasons including:-
 resources,
 lack of knowledge,
 psychological
 and cultural factors that are not consistent
with the proposed plan of care
12/10/2024 18
Beneficence and Non-
maleficence
Beneficence:
– is doing or promoting good
– is the basis for all health care providers
– It lays the groundwork for the trust that

society places in the health profession and
the trust that individuals place in
particular health care agencies.
12/10/2024 19
Beneficence cont’d…
• Medicine aims at achieving good/benefits

(beneficence)
• The positive duty suggested by the
principle of beneficence requires
organizations and mangers to do all they
can to aid patients “Act in the best
interests of others”
12/10/2024 20
Beneficence cont’d…
The principle of beneficence has

three components:
– Promote good
– Prevent harm
– Remove evil or harm
12/10/2024 21
Non-maleficence
Non-maleficence
– is the converse of beneficence
– It means to avoid doing harm/evil
– health care workers must not cause

injury or suffering to clients
– avoiding harm as a consequence of good.
E.g. Experimental research
12/10/2024 22
Non-maleficence cont’d…
• Non-maleficence has been

emphasized and preserved in the
medical slogan ‘Primum non nocere’
which means “above all, first do
no harm!”
12/10/2024 23
Beneficence and Non-
maleficence cont’d…
• The principles of beneficence and

non-maleficence translate into the
duties to maximize benefits while
minimizing harms.
• They are complementary ethical
principles
12/10/2024 24
Justice
• Justice is “fairness” or
“entitlement”; it implies giving to
each his/her due.
• Justice requires that “equals be
treated equally and un-equals
unequally”
12/10/2024 25
Justice cont’d…
• Implies that human beings as moral

equals should be treated equally unless
there is a reasonable justification
for treating them differently.
• Ensure that health care is distributed
in society in a way which is fair and
equitable
12/10/2024 26
Justice cont’d…
• Justice is especially important in
resource allocation
• The principle of justice demands:-
fairness in the treatment of
individuals and communities
the equitable distribution of the
burdens and benefits of research.

12/10/2024 27
Justice cont’d…
• Has important implications for such issues as
 choice of study population,
 recruitment of study subject,
 study and post-study benefits, etc.
E.g. justice would not permit using vulnerable

groups as research participants for the
exclusive benefit of more privileged groups.
12/10/2024 28
Ethical Theories
• Ethical Theories may be compared

to lenses that help us to view an
ethical problem
• They allows us to bring different
perspectives in to our ethical
discussions
12/10/2024 29
Ethical theories cont’d…
There are Four Ethical Theories:
Deontology
Teleology
Intuitionism
Virtue Ethics
12/10/2024 30
Deontology (Duty or Rule based
theory)
The word ‘Deontology’ comes from a Greek
words ‘Deon’ (duty) and ‘logos’ (truth)
 The theory proposes that the rightness
or wrongness of an action depends on
the nature of the act rather than its
consequences.
12/10/2024 31
 It holds that you are acting rightly when
you act according to duties and rights.
E.g. Informed consent, respect of patient

• Therefore, it is not logically necessary to
justify duties by showing that they are
productive of good.
12/10/2024 32
• Only ‘What is right and Wrong?’ is the

moral question not ‘What is good and bad?
Problem: It doesn't allow any flexibility for
exceptions when duties conflict.
E.g. :- Killing punishment
:-Abortion
12/10/2024 33
Teleology (Utilitarian or End based
theory)
• The term ‘Teleology’ derives from the Greek
‘teleo’ (end) and ‘logos’(truth).
• The question of rightness or wrongness is
answered in terms of the question of
goodness.
• It tries to establish a balance of good over bad
consequences
12/10/2024 34
 This theory looks to the consequences of
an action in judging whether that
action is right or wrong.
 Utilitarian hold that no action in itself is
good or bad, the only factors that
makes actions good or bad are the
outcomes or end results that are derived
from them.
12/10/2024 35
Types of Utilitarian Theories
• Act utilitarianism: suggests that

people choose actions that will in any
given circumstances increase the over
all-good.
• Rule utilitarianism: suggests that
people choose rules that when followed
12/10/2024 36
Problem:-
o individual human rights can be
sacrificed to attain a social goal.
o Predicting and evaluating the
consequences of actions is often
very difficult.
12/10/2024 37
Intuitions
• The notions that people inherently know
what is right or wrong; determining but not
a matter of rational thoughts is or learning.
• Human beings have an intuitive moral sense
that enable them to detect real moral truths.
12/10/2024 38
• Something is good because it is

good; its goodness doesn’t need
justifying or proving.
• For example, health workers
inherently known it is wrong to
strike a client, this does not need to
be taught or reasoned out.
12/10/2024 39
Virtue ethics
 It focuses less on decision-making and
more on the character of decision-makers
as reflected in their behavior.
• Assumes ethical behavior follows from
characteristics/traits that people acquire.
12/10/2024 40
• People will do the right thing because they have
developed virtuous habits
• As noted above, virtues that are especially
important for health professionals are
compassion, courage, generosity, commitment
and responsibility.
• Protecting and enhancing client dignity are also
the other virtues
12/10/2024 41
• Any questions ???
12/10/2024 42
12/10/2024 43

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Gambella University

College of Natural and Computational

Four fundamental ethical

• The word autonomy comes from two Greek

Autonomy implies to an individual

– make free choices and

– take decisions without the

• must be able to determine personal goals

• has the capacity to decide on a plan of action

• The application starts with the respect

• Individual autonomy may be diminished or

 mentally handicapped or incapacitated

• Personal autonomy and freedom are

Charles, Gafni and Whelan identify

II. Informed decision making model

III. Professional agent model

IV. Shared decision making model

IV. Shared decision making model

Autonomy of clients is more

• Intentional limitation of another’s autonomy

• Thus, the prevention of any evil or harm is

• Paternalism is appropriate when the

• Non-compliance: Unwillingness of the

– When plans seem unreasonable to the patient

– is doing or promoting good

– is the basis for all health care providers

– It lays the groundwork for the trust that

• Medicine aims at achieving good/benefits

The principle of beneficence has

– Remove evil or harm

– is the converse of beneficence

– It means to avoid doing harm/evil

– health care workers must not cause

E.g. Experimental research

• Non-maleficence has been

• The principles of beneficence and

• Implies that human beings as moral

• The principle of justice demands:-

fairness in the treatment of

individuals and communities

the equitable distribution of the

burdens and benefits of research.

 recruitment of study subject,

 study and post-study benefits, etc.

E.g. justice would not permit using vulnerable

• Ethical Theories may be compared

E.g. Informed consent, respect of patient

• Only ‘What is right and Wrong?’ is the

• Act utilitarianism: suggests that

• The notions that people inherently know

what is right or wrong; determining but not

a matter of rational thoughts is or learning.

• Human beings have an intuitive moral sense

that enable them to detect real moral truths.

• Something is good because it is

 It focuses less on decision-making and

more on the character of decision-makers

as reflected in their behavior.

• Assumes ethical behavior follows from

characteristics/traits that people acquire.