Fundamental Principles

Bioethics

Qualities of principles

• Reasonable + Universal

question

• Are there absolute truths? Truths that cannot change?

• Did the martyrs believe in absolute principles or truths? explain

Faith and Reason

• JCCHS motto: – Where faith and reason flourish– Virtus Scientia (knowledge is a virtue)

• Scientific learning can never contradict the faith.

• “Fides et Ratio”

Morality

• Morality deals with choices. Judgments are about actions and NOT the person.

• What actions are intrinsically evil? CCC 1756 It is therefore an error to judge the morality of human acts by considering only the

intention that inspires them or the circumstances (environment, social pressure, duress or emergency,

etc.) which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object; such as blasphemy and perjury, murder and adultery. One may not do evil so that good may result from it.

Principle of non-contradiction

• Something can not “be” and “not be” at the same time.

• Relativism says truth depends on your perspective.

• MORAL RELATIVISM: morality depends on your opinion

But, what about feelings?

• feelings are morally neutral; - may be clouded by psychological needs,

cultural bias, focus on personal advantage (burning for witchcraft, racism…).

- help us empathize or stay zealous for a right cause

4 bioethical principles from Oxford Univ. Press

• 1. Autonomy• 2. beneficence• 3 utility• 4 justice

Principle of autonomy

• Persons should be able to exercise their capacity for self-determination: – A person should be well informed– A person must give consent to procedure

Prima Facie (not absolute) because autonomy may be curtailed-When undermined by nature or nurture (mental

instability, drug addictions, age…)- when a danger to self or others

Principle of paternalism

Overriding a person’s actions or decisions for his own good

There are many issues when this principle is applied and it is controversial

Eg. A doctor withholds truth from terminally ill patient to spare feelings; experimenting with life-saving treatment without consent; families claiming mental incapacity

Principle of beneficence Principle of nonmaleficence

• We should do good to others and avoid doing them harm– No question doctors should show “due care”– There are debates over to whom this applies – are

we all our brothers keepers? What is our obligation to strangers, the poor…What is the government’s obligation, etc…

Principle of UtilityWe should produce the most favorable balance of good

over bad (i.e. weighing risks…)Eg: • should a doctor perform risky surgery or try

medicine and diet, etc…• should immunization against deadly

communicable disease be required if there is a probability some may have a fatal allergic reaction?

• A company has resources to develop medicine for either a fatal heart disease or a fatal skin cancer – if used for both, neither will succeed, so which do they choose?

Principle of justice

Being fair and giving what is due - distributive justice theories

Libertarian theories: emphasize personal freedoms and rights in a free market – against government assistance and universal healthcare – people have dignity and entitled to only what they require through own work

Egalitarian theories maintain that a just distribution is equal distribution

Interpretation of this principle is currently big in the health care debate

Other principles

• The following have been retrieved from various sources.

• Reminder – the list is incomplete – please suggest additions during the semester

There is a natural law

• What principles have been held by most generations and cultures?

• How is this related to bioethics?

(see video on natural law)

Each person has dignity

• How can people be treated as objects?• How do people potentially place a value

judgment on the quality of one’s life? • Is there ever a person who is not made in the

image and likeness of God? If not, what ramifications does that have?

• How is this related to bioethics?

Principles of integrity and totality

The well being of the whole person must be taken into account in deciding therapeutic procedures.

St. Thomas: “a member of the human body is to be disposed of according as it may profit the whole… if a member is healthy and continuing in its natural state , it cannot be cut off to the detriment of the whole”

(good to cut into someone to heal – but not to mutilate)

Integrity cont….

• Tests, treatments and surgeries include a risk which must be considered…

• Vasectomies and tubal ligations violate the dignity of the human person

• Anytime we treat a person simply as a physical body without regard to his spiritual soul, we violate his integrity.

Do good. Avoid evil.

Natural Law!Review:• Can behaviors be good, evil or neutral?

Explain. • What is moral relativism?• How are these distinctions important to

bioethics?

The end does NOT justify the means

• i.e. One may never do evil that good may come from it

{Machiavelli said the end does justify means}

• Give examples how this principle applies to bioethics. Apply both to a same situation.

Principle of Double Effect• Principle of Double Effect • An action that is good in itself that has two effects--an intended and otherwise

not reasonably attainable good effect, and an unintended yet foreseen evil effect--is licit, provided there is a due proportion between the intended good and the permitted evil.

• When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether the obligation to avoid evil requires one to abstain from a good action in order to prevent a foreseen but merely permitted concomitant evil effect. The answer is that one need not always abstain from a good action that has foreseen bad effects, depending on certain moral criteria identified in the principle of double effect. Though five are listed here, some authors emphasize only four basic moral criteria (the fifth listed here further specifies the third criterion):

(see next slide…)

Double Effect:• The object of the act must not be intrinsically contradictory to

one's fundamental commitment to God and neighbor (including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not be intrinsically evil;

• The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects as far as possible, that is, one must only indirectly intend the harm;

• The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other means of achieving those effects are available;

• The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate judgment);

• The beneficial effects must follow from the action at least as immediately as do the harmful effects.

• What is the difference between consequence that is willed and a consequence that is tolerated?

• How is this related to bioethics?

Principle of SubsidiarityHolds that a larger body and greater body

should not exercise functions which can be carried out efficiently by one smaller or lesser

• Give an example involving authority structures at school?

• Give an example using govt. structures• What does the Catholic Church advise re:

political structures? • How is this related to bioethics?

Suffering is a powerful prayer

• How do we know this?

All is governed by charity

• What is the definition of love?

to will the good of the other

• Considering that union with God in Heaven is a greater good than life, how does this apply to bioethics?

Principles of Cooperation

Formal and material cooperation

Can you guess what they mean?

Principle of Cooperation

• Formal Cooperation. Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares in the agent’s intention, either for its own sake or as a means to some other goal. Implicit formal cooperation occurs when, even though the cooperator denies intending the object of the principal agent, the cooperating person or organization participates in the action directly and in such a way that the it could not be done without this participation. Formal cooperation in intrinsically evil actions, either explicitly or implicitly, is morally illicit (http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=82:principles-of-formal-and-material-cooperation&Itemid=171)

• Immediate Material Cooperation. Immediate material cooperation occurs when the cooperator participates in circumstances that are essential to the commission of an act, such that the act could not occur without this participation. Immediate material cooperation in intrinsically evil actions is morally illicit. There has been in the tradition a debate about the permissibility of immediate cooperation in immoral acts under "duress." When individuals are forced under duress (e.g., at gunpoint) to cooperate in the intrinsically evil action of another, they act with diminished freedom. Following Church teaching, the matter of their action remains objectively evil, but they do not intend this object with true freedom. In such cases, the matter remains objectively evil as such, but the subjective culpability of the cooperator is diminished. Very recently, the Vatican has rejected the arguments of those who would apply this concept of duress to Catholic organizations as a way to justify their immediate material involvement in certain objectionable actions.

• (http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=82:principles-of-formal-and-material-cooperation&Itemid=171)

• Mediate Material Cooperation. Mediate material cooperation occurs when the cooperator participates in circumstances that are not essential to the commission of an action, such that the action could occur even without this cooperation. Mediate material cooperation in an immoral act might be justifiable under three basic conditions:

– If there is a proportionately serious reason for the cooperation (i.e., for the sake of protecting an important good or for avoiding a worse harm); the graver the evil the more serious a reason required for the cooperation;

– The importance of the reason for cooperation must be proportionate to the causal proximity of the cooperator’s action to the action of the principal agent (the distinction between proximate and remote);

– The danger of scandal (i.e., leading others into doing evil, leading others into error, or spreading confusion) must be avoided.

The devil is real

• When Peter tried to dissuade Jesus from suffering and dying, Jesus replied “Get behind me Satan”

• We pray “Deliver us from evil”

Keeping “Screwtape Letters” in mind, how might the devil be involved in bioethics?

Declaration of Independence

• We hold these truths to be self evident (objective truth)

• That all men are created equal• That they are endowed by their creator with

certain inalienable rights• That among these are life liberty and the

pursuit of happiness

Purpose of sex

• Unitive and procreative (babies and bonding)• All ‘problems’ are from denying one or both

What are practices that deny one or the other?

Principle of Proportionate and Disproportionate Means(Ordinary vs extraordinary)

As conceived in the Catholic moral tradition, the principle holds that one is obligated to preserve his or her own life by making use of ordinary means, but is under no obligation to use extraordinary means

• What makes something ‘ordinary means’ or ‘extraordinary means’?

• Terry Shcaivo

Legally ok does not mean morally ok

• Dred Scott decision – 1853 slaves are property with no rights, like ‘chattel’

God loves each person

How is belief in this important in bioethics?