The “Practical Decision Making in Health Care Ethics” has been at the focal point of research across the many fields of studies, precisely in the disciplines of Religion and Theology, Bioethics, Medicine, and Nursing. Raymond Devettere, one of the most renowned researchers and authors in this field, contends that for about fifteen years, “practical decision making in healthcare ethics has offered scholars and students a highly accessible and teachable alternative to the dominant principle-based theories in the field” (Devettere,3-4). Borrowing significantly from the positions held by Aristotle, a classical philosophical thinker, Devettere discusses elaborately the principles of Bioethics in a rather more practical oriented paradigm, to better supplement the understanding of students and scholars, and to reduce the ethical and legal dilemmas in practical decision-making scenarios in “health care ethics” (Devettere, 4 -11).
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The thesis statement
This paper attempts to discuss the interrelationships that exist between four basic principles of bioethics (Beneficence, Non-maleficence, Autonomy, and Justice). Does it seek to find out to what extent does the principle of beneficence relates to that of Non-maleficence? How does the principle of autonomy affect that of beneficence and non-maleficence, and how is it affected in return. If the four principles are to be ranked by their importance, and in a given hierarchical pattern, which one comes first, and why? Is there a possibility of ranking the principles at all? This paper delves into this matter by first considering what exactly does each of these four principles implies as discussed by Raymond Devettere.
The Principle of Beneficence
The principle of Beneficence holds that a health care practitioner is obliged to act not by his or her interests, but in the best interest of the patient. This principle calls for balancing the benefits of receiving treatments against the cost of treatment and the risks possibly involved (Devettere, 9-18).
The Principle of Non-maleficence
Non-maleficence states, there should be no harm to the patient. The non-maleficence principle implies that any action that may harm a patient in any way must be avoided by all means. And because “many treatments involve some degree of harm, this principle also states that the harm should not be disproportionate to the benefit of the treatment” (Devettere, 9 -19).
The Principle of Autonomy
A patient’s autonomy suggests that every patient has a right to reject or accept treatment. This principle requires that a health caregiver respects the views and opinions of the patients concerning certain treatments (Devettere, 9 -19).
The Principle of Justice
According to Aristotle, justice is to give where due. It involves the distribution of scarce health resources by making conscious decisions on who gets what kind of treatment, how, and when. This principle comes in when the patient is not capable of making an informed decision about his or her treatment. The principle allows that surrogates be found to act in the capacity of the patient, in which case, justice has to apply in getting the right person (Devettere, 11 -23).
The principle of Autonomy seems to conflict with that of Beneficence. This comes in when a patient refuses or disagrees with the suggestions of the healthcare provider who in the same vein is indebted to act in the best interest of the patient. Autonomy implies that the patient has the right to refuse treatment, while beneficence requires that the healthcare service provider obeys such a decision made by the patient (Devettere, 13 -27).
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What if treatment is the only way to help the patient, will the physician ignore the patient’s decision of refusing treatment? This may be an ethical dilemma that can shift situations to society, to help the patient. The society here may include guardians to the patient who may be called upon to make decisions on his/her behalf, as surrogates. But even at this juncture, it may not be apparent to the physician, choosing on whom to act on behalf of the health-disabled individual. The principle of Justice is thus upheld, to “give where it is due” (Devettere, 13 -27).
The principle of autonomy and that of beneficence may also overlap with that of non-maleficence. For instance, ignorance of the patient’s autonomy could result in reduced societal confidence in medical services. This may consequently lead to the inability of the practitioners to consider the value of beneficence.
It may not be apparent which of the four bioethics principles mentioned here be given priority. This remains a matter of debate and opinion. However, in my capacity, I would first consider the principle of Non-maleficence, which states that there should be no harm to the patient, or at least only at a minimum degree that is not disproportional to the benefits of the treatment. Getting well through better treatment is often the priority for anyone seeking treatments? This makes this principle weigh more compared to the other three.
The second in rank of importance seems to be that of beneficence which holds that a health caregiver should act in the best interest of the patient by balancing between the risks and the benefits involved in a given treatment. Justice may come next at the third place then the principle of autonomy last.
When justice is considered before autonomy, this may help avoid the conflict that exists between the principle of autonomy and either that of beneficence or non- Non-maleficence. In this way, the many ethical dilemmas that surround the four principles can significantly be reshaped up.
Generally, there have been several ethical and legal dilemmas that have remained unresolved. It hasn’t been made clear as to whether a physician should act in his or her ethical and legal capacity to save the life of a patient, or the patient has more rights than a doctor concerning his or her life. Who makes decisions on behalf of an incapacitated patient has to be a legal issue characterized by a myriad of challenges, involving long and tedious legal frameworks. The above-suggested hierarchy could help if vigilantly considered.
Devettere, Raymond. Practical Decision Making in Health Care Ethics: Cases and Concepts. 3rd ed. Washington, DC: Georgetown University Press, 2009. 3-27