The "ETHICS IN MEDICINE" section of the University of Washington School of Medicine website contains a "Principles of Bioethics" segment. This portion of the website summarizes the 4 fundamental principles of bioethics I have previously discussed in this blog. No new ground is covered in the discussions of respect for autonomy, nonmaleficence, beneficence, and justice.
The "Principles of Bioethics" segment does, however, include an interesting subsection titled 'How do principles "apply" to a certain case?' This subsection considers what to do when two or more bioethical principles are in conflict in an example case. The analysis of the example case is illustrative of non-libertarian bioethical thinking.
The website example case asks the reader to "consider a patient diagnosed with an acutely infected appendix." The reader is informed that the "medical goal should be to provide the greatest benefit to the patient, an indication for immediate surgery." This is the principle of beneficence. The bioethical principle in conflict with this decision, however, is the obligation to not harm a patient, otherwise known as nonmaleficence, for "surgery and general anesthesia carry some small degree of risk to an otherwise healthy patient." The reader is advised that the appropriate course of action is to "balance the demands of these principles by determining which carries more weight in the particular case." The conclusion for the example case is "the patient is in far greater danger from harm from a ruptured appendix if we do not act, than from the surgical procedure and anesthesia if we proceed quickly to surgery."
The non-libertarian finds nothing controversial in the analysis of this example case. The libertarian, however, immediately notes that the discussion completely ignores the ultimate decision-maker in this scenario. The ultimate decision-maker, per libertarian theory, is the justly acquired property owner. The "justly acquired property" in the example case is the appendix of the patient. The owner of the "justly acquired property" in the example case is, obviously, the patient. Thus, the ultimate decision-maker in the example case is the patient with the acutely inflamed appendix. By definition, then, the physician is not the ultimate decision-maker. The physician, therefore, cannot "proceed quickly to surgery." The physician can only "balance the demands of these principles by determining which carries more weight in the particular case" and then give a recommendation to the patient, who will make the ultimate decision.
This shift in focus from the physician as ultimate decision-maker to patient as ultimate decision-maker is the difference between paternalism and autonomy, aggression and non-aggression, slavery and liberty. This distinction may seem trivial to the non-libertarian. The libertarian, once again, knows the truth.
The "Principles of Bioethics" segment does, however, include an interesting subsection titled 'How do principles "apply" to a certain case?' This subsection considers what to do when two or more bioethical principles are in conflict in an example case. The analysis of the example case is illustrative of non-libertarian bioethical thinking.
The website example case asks the reader to "consider a patient diagnosed with an acutely infected appendix." The reader is informed that the "medical goal should be to provide the greatest benefit to the patient, an indication for immediate surgery." This is the principle of beneficence. The bioethical principle in conflict with this decision, however, is the obligation to not harm a patient, otherwise known as nonmaleficence, for "surgery and general anesthesia carry some small degree of risk to an otherwise healthy patient." The reader is advised that the appropriate course of action is to "balance the demands of these principles by determining which carries more weight in the particular case." The conclusion for the example case is "the patient is in far greater danger from harm from a ruptured appendix if we do not act, than from the surgical procedure and anesthesia if we proceed quickly to surgery."
The non-libertarian finds nothing controversial in the analysis of this example case. The libertarian, however, immediately notes that the discussion completely ignores the ultimate decision-maker in this scenario. The ultimate decision-maker, per libertarian theory, is the justly acquired property owner. The "justly acquired property" in the example case is the appendix of the patient. The owner of the "justly acquired property" in the example case is, obviously, the patient. Thus, the ultimate decision-maker in the example case is the patient with the acutely inflamed appendix. By definition, then, the physician is not the ultimate decision-maker. The physician, therefore, cannot "proceed quickly to surgery." The physician can only "balance the demands of these principles by determining which carries more weight in the particular case" and then give a recommendation to the patient, who will make the ultimate decision.
This shift in focus from the physician as ultimate decision-maker to patient as ultimate decision-maker is the difference between paternalism and autonomy, aggression and non-aggression, slavery and liberty. This distinction may seem trivial to the non-libertarian. The libertarian, once again, knows the truth.
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