1.

01
July, 22, 2016
REVIEW OF BIOETHICAL PRINCIPLES
MARIA ZOILA G. CARANDANG, MD.
Department of Bioethics and Legal Medicine

TOPIC OUTLINE Beneficence

I. The Four Ethical Principles • Duty to be of benefit to the patient, to take positive steps to
a. Autonomy prevent and to remove harm from him.
b. Non-maleficence • Duties that is self-evident and widely accepted as the proper
c. Beneficence goals of medicine.
d. Justice
• Applied both to individual patients and to the good of the
II. The Four Quadrant Approach
III. The Case Scenario
society as a whole
IV. Other Pointers • This principle may be the underlying principle for the
a. Dra. Carandang prioritization of health care benefits.
b. Dra. Acevedo • Priority in giving vaccine – child over adult
c. Dra. Mariano • Prioritize the two lives at risk rather than one -- pregnant
women

• However, beneficence is widely seen as a matter of choice
THE FOUR ETHICAL PRINCIPLES
for the physician. He can choose who should benefit from his
• Use only the following principles in solving an ethical services, whom to take into his care by giving himself the

dilemma
V.
o Autonomy Justice
o Non-maleficence
• Justice in health care is usually defined as form of fairness,
o Beneficence
giving to each what is due.
o Justice
• Underlies allocation and distribution of resources and the

concept of right to health care
Autonomy
• With or without money, patient must be given care.
• Take in mind that physician must present right and complete
information with regards to patient’s decision • Involves:
o Distribution of burden
• Physician must use NON-MANIPULATIVE CO-DECISION
o Availability and use of benefits
MAKING.
o Compensation (ex. participants in research)
o Be creative in convincing patient so that both of you
o Prioritization in the use of funds
would cooperatively arrive to a decision or an
agreement • Distribution of health services take different forms:
o To each person an equal share
• Self-governance
o To each person according to need
• Patient has the capacity to act intentionally, with
o To each person according to effort
understanding, and without controlling influences that could
o To each person according to contribution
mitigate
o To each person according to merit
• Decides/act freely and voluntarily without duress o To each person according to free- market exchange
• Informed consent must be signed by the patient and not
anybody else unless emergency (proxy consent)
THE FOUR QUADRANT APPROACH
• Basis of autonomy is informed consent. It emphasizes the
• Assess the Issues
need for competence and voluntariness to consent or
o What is the medical situation/identification of the
withdraw
problem (Close contact/Casual Contact: In the case,

there is high communicability of the disease from the
Non-Maleficence
father, the patient, to his children)
• Requires not intentionally creating needless harm or injury o Identification of the Problem
to the patient, either through acts of commission or omission
• Patient’s Preferences
or imposing a careless or unreasonable risk of harm upon
o Physician must not only respect the patient’s preference
him.
but also to educate and give the correct information
• This principle is the basis for standard care and reaffirms regarding the patient’s preference
the need for competence. It also emphasizes risks and
o Physician should explain the consequences or outcomes
benefits.
of the patient’s autonomous decision (e.g. “kuya, baka
• Weighing the risk-benefit ratio -- benefit must be greater lumala po iyan, at baka mahawa din po yung mga anak
than the risk. niyo”)
• Non-maleficence is applied in the definition of negligence, • Issues outside the Medical Facts/Alternative Courses of
physician’s error, and medical malpractice Action
o Financial Issues
o Health System Issues (i.e. healthcare delivery system,
TB dots etc.)

1 of 2 [PEÑA and GUIAMANO]

 REVIEW OF BIOETHICAL PRINCIPLES

• Implementation of the Action

THE CASE SCENARIO
• GH is a 30 year old tricycle driver married with 3 young
children. His family lives in an extended home with 2 other
families. He consulted you at the LHC where you are
assigned, for pleuritic chest pain and progressive dyspnea.
He has had weight loss and chronic cough for the last 3
months. You suspect TB with Pleural Effusion and advised
chest films, sputum exam as well as possible admission for
further management in OM. He refuses admission due to
financial concerns and requested for a prescription of cough
medicine and pain reliever

*(USE FOUR QUADRANT APPROACH)*

Other POINTERS
• Dra. Carandang
o In making ethical decisions, you must not only consider
the patient but also the people whom he has contact
with
o There is no simplistic way in favoring one ethical
principle over the other. It is more of balancing the four
ethical principles in arriving a particular ethical
decision.

• Dra. Acevedo
o Always Identify the Problem (The Medical Problem)
o Do not jump to the solution (don’t do shortcuts, and be
complete)
o USE the FCM approach (Public Health Crisis)

• Dra. Mariano

o Always report the disease (i.e. the mode of

transmission, the pathogenesis, etc.)

o Always look at the background/belief of the person

(Health-Belief Model)

o Always ask questions on what is going on inside the

patient’s mind



REFERENCES:

• 2C (2018)

• Drs. Acevedo, Carandang, and Mariano’s lecture



TRANSER’S MESSAGE

“A man without ethics is a wild beast loosed upon this
world.” – Albert Camus

2 of 2 [PEÑA and GUIAMANO]