Six Ethics: A Rights-Based Approach to Establishing an Objective Common Morality

What action is morally allowable, or, what is our duty? It is argued in this case that the woman has the right to self-defense, and the action of the hysterectomy is aimed at defending and preserving her life. The foreseeable unintended consequence though undesired is the death of the fetus. There are four conditions that usually apply to the principle of double effect:. The reader may apply these four criteria to the case above, and find that the principle of double effect applies and the four conditions are not violated by the prescribed treatment plan.

The Principle of Beneficence The ordinary meaning of this principle is that health care providers have a duty to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient. These duties are viewed as rational and self-evident and are widely accepted as the proper goals of medicine. The goal of providing benefit can be applied both to individual patients, and to the good of society as a whole. For example, the good health of a particular patient is an appropriate goal of medicine, and the prevention of disease through research and the employment of vaccines is the same goal expanded to the population at large.

It is sometimes held that nonmaleficence is a constant duty, that is, one ought never to harm another individual, whereas beneficence is a limited duty. A physician has a duty to seek the benefit of any or all of her patients, however, a physician may also choose whom to admit into his or her practice, and does not have a strict duty to benefit patients not acknowledged in the panel. This duty becomes complex if two patients appeal for treatment at the same moment. Some criteria of urgency of need might be used, or some principle of first come first served, to decide who should be helped at the moment.

Case 3 One clear example exists in health care where the principle of beneficence is given priority over the principle of respect for patient autonomy. This example comes from Emergency Medicine. When the patient is incapacitated by the grave nature of accident or illness, we presume that the reasonable person would want to be treated aggressively, and we rush to provide beneficent intervention by stemming the bleeding, mending the broken or suturing the wounded.

Discussion In this culture, when the physician acts from a benevolent spirit in providing beneficent treatment that in the physician's opinion is in the best interests of the patient, without consulting the patient, or by overriding the patient's wishes, it is considered to be "paternalistic.

Rights-based approach to development

Here, the duty of beneficence requires that the physician intervene on behalf of saving the patient's life or placing the patient in a protective environment, in the belief that the patient is compromised and cannot act in his own best interest at the moment. As always, the facts of the case are extremely important in order to make a judgment that the autonomy of the patient is compromised. The Principle of Justice Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "giving to each that which is his due.

The question of distributive justice also seems to hinge on the fact that some goods and services are in short supply, there is not enough to go around, thus some fair means of allocating scarce resources must be determined. It is generally held that persons who are equals should qualify for equal treatment.

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This is borne out in the application of Medicare, which is available to all persons over the age of 65 years. This category of persons is equal with respect to this one factor, their age, but the criteria chosen says nothing about need or other noteworthy factors about the persons in this category. In fact, our society uses a variety of factors as criteria for distributive justice, including the following:. John Rawls and others claim that many of the inequalities we experience are a result of a "natural lottery" or a "social lottery" for which the affected individual is not to blame, therefore, society ought to help even the playing field by providing resources to help overcome the disadvantaged situation.

One of the most controversial issues in modern health care is the question pertaining to "who has the right to health care? Medicaid is also a program that is designed to help fund health care for those at the poverty level. Yet, in times of recession, thousands of families below the poverty level have been purged from the Medicaid rolls as a cost saving maneuver. The principle of justice is a strong motivation toward the reform of our health care system so that the needs of the entire population are taken into account. The demands of the principle of justice must apply at the bedside of individual patients but also systemically in the laws and policies of society that govern the access of a population to health care.

Much work remains to be done in this arena. The four principles currently operant in health care ethics had a long history in the common morality of our society even before becoming widely popular as moral action guides in medical ethics over the past forty-plus years through the work of ethicists such as Beauchamp and Childress. In the face of morally ambiguous situations in health care the nuances of their usage have been refined through countless applications. Some bioethicists, such as Bernard Gert and colleagues , argue that with the exception of nonmaleficence, the principles are flawed as moral action guides as they are so nonspecific, appearing to simply remind the decision maker of considerations that should be taken into account.

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Indeed, Beauchamp and Childress do not claim that principlism provides a general moral theory, but rather, they affirm the usefulness of these principles in reflecting on moral problems and in moving to an ethical resolution. Gert also charges that principlism fails to distinguish between moral rules and moral ideals and, as mentioned earlier, that there is no agreed upon method for resolving conflicts when two different principles conflict about what ought to be done. Further, bioethicst Albert Jonsen and colleagues claim in their work that in order to rigorously apply these principles in clinical situations their applicability must start with the context of a given case.

This article is intended to be a brief introduction to the use of ethical principles in health care ethics. Students of clinical ethics will find additional information and deeper analysis in the suggested readings below.

References Beauchamp T, Childress J. Within this theory development will no longer be viewed as a gift or a need, but rather a right that states and governments are held accountable for. NGOs that have implemented rights-based approach to development have done so with four main principles to follow. These principles are human rights-based approach design of their programs, education about rights-based approach, rights to participation, and accountability.

Human rights-based approach design of their programs begins with analysis of the unfulfilled human rights. It then commits programs and funds to fulfill these missing human rights. The design of these programs also stresses that the donations are not a gift but rather that the people are finally receiving the human rights treatment they deserve. Education of human rights and the programs that are being implemented is important.

The education is to inform the beneficiaries of their human rights as well as the ways in which NGOs and other organizations are attempting to increase their human rights. Education is also to inform the governments, international organizations and donor agencies that are dealing with human rights their roles and responsibilities. Then there is the principle of rights to participation. This deals with the idea that beneficiaries should be included when implementing programs on their behalf. Organizations should include the beneficiaries to help empower.

Then there is the principle of accountability which is designed to have standards of human rights and development. It is also designed for NGOs, international organizations, donor agencies and governments to be held to a higher standard of responsibility. Amnesty International and Human Rights Watch are two NGOs that have been involved traditionally with advocacy in relation to human rights. These NGOs have expanded from traditional political rights to expand to ESC rights, which includes economic and social rights as well. Oxfam is an NGO that has adopted the rights-based approach to development.

Oxfam vowed to continue to provide relief while also addressing the structural causes of poverty and injustice. This approach combines poverty, human rights, development and trade all within the same realm. Oxfam focuses a broad approach to the causes of poverty and injustice. This NGO also would like to put economic and social justice at the top of the world agenda.

The shift towards a rights-based approach to development forced Oxfam to reexamine its funding, a deeper examination into the state's role as a duty bearer, and using civil society as a vehicle for citizens to empowered to stand up for their rights. Oxfam also had to evaluate their development practices and business model. There has been a shift from focusing upon civil human rights to human rights of social and economic areas. There are many NGOs that are now focusing upon the ESC economic and social rights while creating and implementing programs.

These rights focus on alleviating poverty and implementing equal social and economic rights in all levels of society. NGOs that have implemented these ESC rights are focusing much of their attention on increasing the standard of living to be healthy and safe.

This includes ideas of water rights in areas that lack clean drinking water and health rights that include availability of medicine and doctors. This would increase the impoverished peoples' standard of living by increasing basic living needs and access. Beginning in the late s when rights-based approach to development began to be a popular discourse many aid donor agencies began to support this view towards development.

Their intentions are to implement support for programs to incorporate both development and human rights in an interdisciplinary fashion. Other UN programs have also adopted the rights-based approach to development. This new development framework leads to moral legitimacy and social justice. UNDP specifically focused upon the interactions of social and economic rights. Their focus was to help develop policy decisions related to social and economic rights in association with development.

In UNDP published "Human Rights and Human Development" a document that provided their intentions and strategies based on their implementation of rights-based approach to development. UNDP also provides tools for governments and donor agencies to support the rights-based approach to development. Perspectives from International Development Agencies".

Institute of Development Studies. Retrieved July 10, UNICEF is another donor agency that has implemented the rights-based approach to development and its ideas. NGOs transitioning to rights-based approach have to redefine missions, test new methodologies, reallocate funding, and train staff. To do this there are a few steps NGOs have to take in developing programs and campaigns around rights-based approach. First, NGOs need to create program ideas.

These are created based on an analysis of rights within a certain country. The analysis is necessary to identify and give priority to the most deprived in society. It is then the goal of a rights-based approach to empower those people. This step also identifies and reviews the capacity of the duty-bearers. It also tries to understand the relationship between the rights holders and the duty bearers.

The next step is to educate both the rights holders and the duty bearers by articulating the rights of citizens and duty of the government. This is an important step so both parties are knowledgeable about their individual rights, responsibilities, and roles in society. This enables effective communication necessary between rights holders and duty bearers. After an extensive situation analysis , a project or program is developed.

The program needs to address human rights deficits related to certain groups, communities, or countries facing abuses or discrimination. Baselines and benchmarks are set, which create transparency and accountability in the project. Goals are also created during this step in order to analyze the program's effectiveness in a human rights context at the end of the project. This is exactly the criticism of Herissone-Kelly: From here they seek protection even implicitly in what Donagan describes as defined and not defined predicates — one being more primitive and therefore universal while the other is more specific, or in other words closer to practical applicability, but without universal scope This is further evidence that they cannot justify the universality of common morality as they initially attempted, and must now try to reduce it, both in its reasoning and its applicability.

The common morality theory in the work of Beauchamp and Childress

Gordon, Rauprich and Vollmann, however, chose to support the creators of principlism. Instead, they defend principlism for its usefulness, and not for its coherence or theoretical consistence. This is another attempt to avoid criticism, as the key issue is not the practical applicability of principlism, but in the way it has been used.

This search for universality was also performed by Kukla 28 — an innocuous strategy according to Strong, as common morality dispenses with universal acceptability, but not universal applicability 24 ; in other words, it is not its nature that is important, but how it will be used in practice. Both Holm 29 and Luna 16 claim that, despite the major change that the introduction of common morality in the 4 th edition represents, it was in the next issue that the authors of principlism began to respond more strongly to the criticism they had suffered since the inaugural edition, which led to even greater changes in the content of the work.

Instead, they would concern themselves with the aspects of common morality that they had assumed, focused on questions of method and justification in biomedical ethics This is because Clouser and Gert, hoping to find in principlism a theory — or in other words, a doctrine endowed with unity and a systematic connection between rules, a clear model of justification and a practical decision making process — began to criticize the work from onwards, or in other words, between the publication of the 3 rd and 4 th edition of the study However, it is not only their own work which they refer to in these terms, but also the theories of Frankena and Ross, perhaps as a way of removing the concept of theory and at the same time placing their work, which is not a theory, at the same level as two of the most renowned names in philosophy.

They also as resume their support for the possibility of the existence of a universalism in common morality, in the same manner they initially advocated - namely a universalism in which all share the same morality He concludes by stating his intention to make use of the 6th edition, as he did the previous editions, as one of the most key texts in his Philosophy of Medicine course. The authors state that in order to formulate their principles of biomedical ethics, they resorted to common morality, even though they recognize that the rules of the same go beyond the principles on which they focused when conceiving principlism 1 , Only in the 5 th edition have they admitted this, because, as they describe it, theories merely try to seize the moral point of view, with morality becoming the anchor of the theory, and not vice versa They even say that if an ethical theory rejects any of the four principles advocated in their work, they would have reason to doubt the theory, not the principles Thus, they demonstrate that they rely more on principles than on theory, perhaps because principlism itself cannot be a theory….

The authors rebut these arguments in the same 4 th edition, arguing a priori that these are not, in fact , solvable issues and that no system of action guides could reasonably anticipate a complete list of conflicts 2.

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In their view, it represents a virtue of principlism that it requires specification, or in other words, complementation, whereas it is a defect of the theory of Clouser and Gert to try and escape this, by drawing on rules 2 , Beauchamp, in an article published individually in 30 , when trying to counteract the criticism of Kukla on the subject 28 , again exhibits the brittleness of principlism, as he fails to present a method, but merely provides examples of situations in which the theory may be applied, such as in relationships of trust and in animal laboratory research In principlism, this works as a way to control bias and the lack of objectivity in the choice of the judgements considered, using information about what is widely, or preferably universally, agreed to be correct For Strong, however, even this method does not serve the requirements of principlism.

As such, the approach taken is similar to that adopted in relation to the theory of common morality of Clouser and Gert 31 , Thus, they abandoned the defense of a universalism in which all individuals have the same common morality which could not be sustained for the defense of another universalism in which all possess a common morality, even if each has his or her own, individual morality.

To avoid criticism, in the 5th edition the authors acknowledged that they would no longer defend the existence of a single common morality, nor of its theory, and even claimed to present their own version of common morality theory. Principles of biomedical ethics. Oxford University Press; Common morality as an alternative to principlism. Kennedy Inst Ethics J. A waste of time: Applying the four-principle approach. A defense of the common morality. The foundations of bioethics. Consistency, common morality, and reflective equilibrium.

Nascimento WF, Garrafa V. Clouser KD, Gert B. A critique of principlism. Garrafa V, Porto D. Not just autonomy — the principles of American biomedical ethics.



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A matter of principles? Camb Q Healthc Ethics. Introduction — common morality. The theory of morality. The University of Chicago Press; Specification and other methods for determining morally relevant facts. On common morality as embodied practice — a reply to Kukla. Wide reflective equilibrium and the justification of moral theory. Essays in honour of Robert Heeger. Kluwer Academic Publishers; Volnei Garrafa oriented the first author, guiding the conception and design of the study as well as the preparation and review of the article.

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Services on Demand Journal. Research article The common morality theory in the work of Beauchamp and Childress. Bioethics; Morals; Ethics; medical; Ethical theory. Common morality theory and its relationship with principlism Just like with other moralities, standards of common morality are learned over a lifetime. Criticism of the use of common morality theory Clouser and Gert claim that moral theories, when well-structured, are capable of reflecting the universality of morality and of the self-elimination of drift, and are never a set of principles and rules related in a more or less systematic form Method A qualitative research survey was carried out by analyzing the content of pre-selected literature