Inevery day’s life as healthcare practitioners, we are confronted byboth major and minor ethical choices while providing services topeople with various values, and who live in the pluralist andmulticultural communities. In such cases, it is necessary to havedefined moral guidelines to evade confusion and conflicts in our lineof service. This concept necessitates the aspect of acceptability ofthe principles in the contextual population. However, because of themany differences that exist in the in the clinical settings, and theinvestable fact that there are many applicable principles in varioussituations, the laws are not seen as absolutes but rather as dominantguides to clinicians. The four core principles are not hierarchicalhence none supersedes the other. However, one could argue that whenfaced with a medical situation, one should apply all of them whichcannot be possible because they conflict with one another in somecases.
Itis, therefore, essential to focus on the principles, a healthcaresituation they are applicable and the laws that are in conflict withthe same situation.
Thefour principles that are regularly accepted in the medical serviceethics are the principle of respect for independence, the principleof nonmaleficence, the principle of beneficence and lastly the one ofjustice (Brugger, 2016).
Anythought on the morality of decision-making process assumes thatsensible parties are involved in the course of making conversant andvoluntary verdicts. In the clinical field resolutions, the respectfor the patient`s autonomy, in collective phrasing, implies that thepatient can act deliberately, with information, and withoutinfluential externalities that would alleviate the chance of making afree and voluntary move (Phillips, 2011). It forms the basis for theinformed consent practice in the transactions between the patient andthe doctor.
Thisstandard calls us not to harm or injure the patient throughcommission and omissions deliberately. In plain language, this meansthat it is termed negligence if a therapist creates an inconsideraterisk of damage to the patients. Provision of quality standardizedcare that eludes or reduces the harm risks is not only supported bythe commonly known moral convictions but also in the society laws.The principle insists on the need for competency among physicians. Wemust be committed to protecting patients from harm.
Fromthe word, it means that medical providers have a responsibility tobenefit the patients and also to take sacrificial steps to avert andeliminate harm for them (Herrissone, 2011). These duties have beendeemed to be normal and self-proclaimed and are globally recognizedas the proper objectives of medicine. This standard is bothapplicable to the particular patient and the good of the society. Forinstance, the primary goal of medicine is to maintain the rightpatient`s health while the prevention of ailments through studies andvaccination is still the same objective when extended to thecommunity.
ThePrinciple of Justice
Inthis context, it is described as the concept of fairness. It meansthat there must be a fair distribution of items and services in thesociety and there is need to focus on the role of privilege.Therefore, individuals who are equals should receive the sametreatment regardless of their needs or other notable factors in thecategory. Several parameters determine level of justice accorded toan individual contemporarily like equal share, needs, effort,contribution, merit and the free market exchanges.
Thisaspect means that the health institutions should get back the valueof the enormous sums of money they are investing by coming up withlimits on the kind of treatments that need to be paid for in thepublic centers.
Oneof the situations is the decisions made in this context touches onbed triage moves in Northern America, European countries, Israel andHong Kong. Approximately 15% of the patients were denied admission inICU out of which a larger percentage was attributed to lack of beds.Furthermore, the patients were much ill both at admission anddischarge, the average periods spent in the ICU were made shorter andvery few patients were admitted and monitored. Some facilities haveeven gone higher to reduce the use of ICU by establishing mechanicalventilations in the wards. ICU services are always expensive and inthe majority of cases are not successful. This notion has made it anideal area to make rationing decisions (Cooper et al, 2011).
Appliedand Conflicting Principles
Inrationing of the ICU services the principle of justice comes inhandy. The priority on who is considered is guided by the parametersof justice. For instance, individuals could be admitted for shorterperiods of time to give room for others, admitted to the facilityaccording to their conditions, their efforts, the forces of the freemarket or accepted in attempts by the institution to optimize thegeneral effectiveness (Huxtable, 2013). However, the situation seemsto conflict with the beneficence principle which insists that thecare should be for the benefit of the patient. For instance, thenumber of admissions is limited thus restricting the number of thosewho are benefiting from it. Similarly, when the periods of access areshortened, it may be contrary to the wish of the patient and thefamily which infringes on autonomy.
Brugger,E. C. (2016). The First Principles of the Natural Law and Bioethics.ChristianBioethics: Non-Ecumenical Studies In Medical Morality,22(2),88-103.
Cooper,A. B., Sibbald, R., Scales, D. C., Rozmovits, L., & Sinuff, T.(2013). Scarcity: The Context of Rationing in an Ontario ICU.CriticalCare Medicine,41(6),1476-1482.
Herissone,P. (2011). Determining the common morality`s norms in the sixthedition of Principles of Biomedical Ethics. Journalof Medical Ethics,37(10),584-587.
Huxtable,R. (2013). For and against the four principles of biomedical ethics.ClinicalEthics,8(2/3),39-43.
Phillips,S. A. (2011). Bioethics: Principles, Issues, and Cases. Ethics& Medicine: An International Journal of Bioethics,27(2),124-125.