Biomedical Ethics By Beauchamp Philosophy Essay

The Four Principles of Biomedical Ethics by Beauchamp and Childress

And Applying Them for a Given Scenario

Adham R. AlArbeed


Assignment 1

Dr. Keith Cash

NU (542): Ethics in Health Care

The Aga Khan University School of Nursing and Midwifery

February 21th, 2012

I have fully acknowledged the work of others in an appropriate way. I have not used, received nor have I given material without permission while writing this assignment. I affirm that I have maintained the principles of honesty and integrity in my academic work.


Autonomy, beneficence, nonmaleficence, and justice are the four fundamental principles of biomedical ethics. Those principles considered as the foundational basics for the moral decisions. The moral decisions which we need to take daily in the health care field. Depending on the nature of the health care work, which demands us for such a decisions continuously. Especially, the nurses whom they are in interaction with the patients most of their time. Nurses are required being aware of those principles. In ordered to be able to make good moral decisions, at the same time to be able to justify it. Therefore nurses should be aware of the obligation of maintaining the autonomy of the patients in the first hand. While in the second hand, trying to achieve the balance between the beneficence and the nonmaleficence of their decisions. Nonetheless being justice in the distribution of the care at the same time.

A Review for the Four Principles

The first principle the autonomy which means the ones right to decide for himself. A concept related to freedom, were the rising of the individualism in the western society played a major role of its presence. However, freedom do not come alone, it always conveys responsibilities with it. Thus even if one is free to decide, still he needs sufficient knowledge about the decision he is going to take. Otherwise freedom will become chaos. Feinberg stated that "autonomy minimally requires the ability to decide for the self-free from the control of others and with sufficient level of understanding as to provide for meaningful choice"(as cited in Lawrence, 2007).

In the light of that, autonomy should be described as the ones right to decide for himself, when he is aware completely to the impacts of his decision on himself and others.

The second principle, beneficence means the importance of providing the benefits for others through our decisions. In fact, we can generalize by saying that most of the traditions and religions asserted for its importance. Lawrence (2007) explains what Beauchamp and Childress suggest as an explanation for the concept of beneficence, within two principles positive beneficence and utility. The principle of positive beneficence deal with the benefits provided by the moral agents , while the principle of utility demand that the moral agents must weigh the benefits and the hazards in order to produce the best results.

The third principle, nonmaleficence means to avoid producing harm for others through our decisions, either intentionally or non-intentionally. It is related to the second principle the beneficence, and the relation is in the shape of balance we need to achieve. Therefore, we have an obligation while taking a moral decision. This obligation is to try to achieve that balance between the benefits and the risks of our decisions always.

Justice is the fourth principle; basically it means to provide the care for our patients equally, Regardless to their differences. Again we can generalize by saying that it is a concept derived from most of the tradition and religions, like the two previous concepts. The concept of justice addresses queries about the distribution of the healthcare resources. Especially, in the developing countries were the lack of resources is a major problem there. Thus, in the absence of the privation of resources fulfilling the concept of justice become less challenging. However the problem of the lack of resources is always there. For that many approaches have been suggested to insure a fair distribution for the health care resources. As reported in the material which has been provided for this assignment, most of those approaches take in consideration the needs, the desert, the rights, and the utility as a basis for planning the distribution of the health care resources. Whereas depending on one alone is a problematic. Therefor, a combination of the entire basis together as a key for planning the distribution of the health care resources will be always the best approach.

To summarize this part, it is essential to say that the four principles are integrating with each other. Thus in order to achieve one principle, we had some times to face a conflict with the rest of the principles. The moral dilemmas usually created by these conflicts between the principles.

Compare and Contrast the Four Principles

On a scenario, were a nurse is assigned for a patient who has been diagnosed with an inoperable tumour and is terminally ill. The medical staff and the family insist that she is not to be told about her prognosis. She keeps asking the nurse, "Am I dying".

What should the nurse do in this situation?

The reality of the dilemma in this case comes from the main conflict between the autonomy and the nonmaleficence principles. At the same time, it includes the second principle the beneficence because of its relation with the nonmaleficence. Nonetheless it is very important to take in consideration while taking the decision the patient level of orientation, ability to judgment, and spiritual beliefs. At the same time we need to keep in our mind the rules of the work place and the culture context of the society. Therefore the decision may vary depending on those factors. Still the four principles of Beauchamp and Childress seem to be helping tools toward a good and justifiable moral decision.

First of all, the obligation to respect the patient autonomy is the first thing in which the nurse must keep in her mind while taking the decision. The patient has the right to know for many reasons. Let us say for example, that she has a heritage and she want to write a commandment. Then who will take the responsibility if she did not? Nonetheless while the family expressed their wishes about keeping the information from the patient, so how we can be sure of their good intentions in this case? Furthermore if the patient is oriented and able to make correct judgments for herself, in this case what is the justification to keep the information from her? In fact to keep the information from her is completely inappropriate. For all of that and to respect the patient autonomy it seems better to inform her.

Second, there is the obligation to respect the principle of nonmaleficence. In other terms, to keep the balance between the nonmaleficence and the beneficence. Toward providing the information for the patient about her case. In the first hand, we must try to prevent the possible harm of distressing the patient. In the second hand, we need to admit the possible benefits of providing the information. This drives us to make further investigations before we become able to decide. According to that a complete study for the patient judgmental abilities and spiritual beliefs is what we need.

Third, to understand the patient status and back ground in order to take a justifiable decision we need to study the patient status. First, we need to be sure that the physical problem the patient has does not affect her judgmental abilities. Many things can be negotiable toward the patient ability to take a decision, according to Beauchamp and Childress "inability to express preference, inability to understand one’s situation and its consequences, inability to understand relevant information, inability to give a rational

reason, inability to give risk and benefit reasons, inability to reach a reasonable decision" (P. 137). It is obvious then that if the patient unable to make rational decisions because of her disease, the case become simple and we better to deal with her as the unconscious patient. Where taking a decision there is easier because we do not have a patient autonomy to respect, so we count on our own experience and preference. Second, we need to know the educational back ground of the patient. A study made by Dias, Chabner, Lynch ,and Penson (2003) refers that knowing what to expect and making plans for how to proceed can help make this stressful time for the patients easier. Patients with enough education seems more able to understand the reality of their diseases process, and seems to be more able to tolerate such situation. Third, we need to know the patient religious beliefs which are an important factor here. Koenig(2004) explains about how those patients who have spiritual and religious beliefs seems to be more able to tolerate such stressful situation .

The reality of the need for all this information about the patient status and background, in order for the nurse to be able to take justifiable moral decisions is problematic. That is because we have to face the problem of being justice with both the nurse and the patients. Questions need to be asked here like, in case of the huge work load which nurses usually have, is there enough authority and time for the nurse to pursue such information about the patient? Otherwise if the nurse does not have such authority and time then it is not justice to ask her to make such a decision. Then another question arises here is the nurse allowed to release such information according to the work place roles? If not then it is an appropriate for her to answer regardless to her opinion about the subject.

As to conclude this part, it seems to be more appropriate for the nurse to be aware of the patient status completely before taking a decision, about what to give as an answer to her patient question. Furthermore, the nurse should be able to justify her decision in the light of her understanding for the four principles. At the same time she should be aware of the consequences of her action on herself, on the subject of the work place rules and the culture context of the society.

A Correct Moral Decision

A correct moral decision is something unachievable, because simply there is nothing completely correct or completely wrong in the moral situations. It is better to say that a good and justifiable moral decision is a vast aim to pursue. That is related to the process of taking this kind of decisions. Were we are weighing the benefits against the risks keeping in mind the respect for the autonomy and justice. Still the fact remains that the four principles of Beauchamp and Childress will remain a very good approach toward taking such decisions. Lawrence (2007) stated that "Principlism provides a working set of tools that are used every day in modern health care" (p.40). In this context, it seems right to advice all the health workers to rely on the four principles when they face a moral dilemma.

To Improve our Moral Judgment

Toward improving our abilities to make a good moral judgment and moral decisions, we need to expand our knowledge. For that information should be provided to the nursing staff, through a text books contains a guide lines for moral decision making. Furthermore policies should be established and improved with time to produce a work frame for the staff nurses. A book like the "American College of Physicians Ethics Manual" is to be considered as a respectable example to be followed. The highly-educated professional nurses need to start their pursuing to provide such books for the nurses community. Furthermore, it seems appropriate to say that moral situations with a complex nature need a specialist people to deal with. In that context, it looks decent to suggest that every work place need to establish a biomedical ethical committee contains experts in this field. While at the same time a central committee for the entire country should be established. A central committee affiliated to the ministry of health should be the highest authority for this aspect in the health care systems.


In conclusion for this paper, I would like to quote Jean-Paul Sartre when he said that "Words are loaded pistols". The fact about the huge impact of the information in certain occasions is evident .Therefore we better to study each patient status as an individual case. Then to learn more about ethical decision making and to know the right tools to use in our decision making process. Then together with all that and our own experience we take a moral decision. A moral decision that, we can justify it and be responsible for it. At the same time we can be sure, at least on the long term, of its positive impacts on our patients.