Principles Of Biomedical Ethics: Morality, Autonomy And No Maleficence.

Principles of Biomedical Ethics: Morality, Autonomy and No Maleficence.

Initially it is important to clarify and start from the fundamental and simplified concepts of morals, ethics, bioethics, and medical ethics, to achieve an approach to the principles of biomedical ethics and their interpretation addressed by the authors in the text. Morality is defined as the set of rules that are generated individually or in a group and that are applied to the daily life of citizens. These norms guide each individual, guiding their actions and their judgments about what is moral or immoral, correct or incorrect, good or bad. In other words, morality refers more to first -order beliefs and practices that imply a set of established judgments. While ethics is a more generic term, ethics is more reflective when questioning why some behaviors are considered valid and others not, that is, seeks and analyzes the foundation of each behavior. If ethics are defined, as a science, it is a set of knowledge derived from the research of human behavior by trying to explain moral rules in a rational, theoretically and scientifically based. It is a reflection on morality. Provides the theoretical basis to assess why something is good or bad. 

However, the concept of bioethics is much more comprehensive, given the interdisciplinary nature of its nature, bioethics integrates several disciplines in order to promote social good, bioethics tries to address complex problems raised in the specific scope of health care andIt has progressively expand its approach to study the natural, technological and social factors that can have repercussions on human health and the biosphere as a whole.

And medical ethics is a discipline that accompanies the doctor throughout his professional life, guides the behavior of the medical professional towards the correct medical act, and promotes the achievement of an ideal standard and of excellence of the relationships that he must establish withthe sick.

It is interesting to analyze the review of the different ethical theories and approaches (normative, non -regulations: descriptive and metaética), underlying in current bioethics, which the authors propose with the intention of discovering what were the elements they used, to present the proposal ofthe four "basic principles" (autonomy, beneficence, no malevolence and justice).

To get to understand them it is necessary to understand what is a principle?, The principles guide the professional towards a particular approach in the solution of a problem, they can also fulfill the justification function, they are general norms, they are necessary and sufficient to resolve the ethical dilemmas, they consist of rules that order the arguments and allow to solve theVarious situations, principles and rules are considered to force prima facie and have no absolute character, allowing conflict situations, based on the principle that predominates in the particular health situation. In the field of bioethics, they serve to guide decision making in current or complex situations.

Among the ethical methodologies described by the authors to explain the formulation of these four principles, three stand out: first the ethical deductivism or model of generic precepts, which establishes that moral judgments or assessments are made from certain pre -existing normative preceptsthat are more general than concrete judgments. From there the specific action rules are derived. As stated by the authors, this scheme may not be applicable to all problematic cases, because clinical reality is more complex, it can be affirmed that moral deductivism runs from top to bottom, from the most universal statements to the mostindividuals. Prioritize the general and theory.

The second method described is inductivism, or the model based on individual cases, ethical reasoning is methodologically part of the analysis of specific facts or cases to reach generalizations. The rules of moral action must use pre -existing social agreements and practices as a starting point, and from there generalize norms as principles and rules, generalizations derived from experience and forms of thought in ethical issues. Inductivism, runs from the bottom up, from particular and unique to the most universal (4) . Thus prioritizes experience and prudence.

And finally they conclude with a last different scheme of moral reasoning, called the coherentism or method based on the reflective balance described by John Rawls, this is neither descending or ascending;moves in both directions. They tell us about the need to formulate weighted judgments, that is, the “judgments in which our moral abilities can be deployed without distortions”, the reflective balance to which the authors refer, should serve to polish, retouch those judgmentsweighted so that they are consistent with the ethical theory in which they find their foundation. In other words.

With the understanding of these methodologies described above, the formulation of the four basic principles or ethical duties are reached, which must serve to guide the behavior to follow:

Respect for autonomy: the word "autonomy" comes from Greek and means "self-government". For the authors, the autonomous individual is the one who "acts freely according to an autoesquecogido plan". According to the authors, all autonomy theories agree on two essential conditions: a) freedom, understood as the independence of influences they control, and b) the agency, that is, the capacity for intentional action.

The meaning that some theories give to an autonomous person has the following features: exceptionally authentic, self-posted, consistent, independent, self-governor, resistant to control by authorities, and original source of personal values, beliefs and life plans. Beauchamp and Childress, understand that this ideal of autonomy is very high and that very few can aspire to achieve it.

It is important to take into account the notion of autonomous action;when the one who acts does a) intentionally, b) with understanding and c) without controlling influences that determine their action. In order to determine whether an action is autonomous, we have to know whether or not it is intentional and, in addition, check whether it exceeds a substantial level of understanding and freedom of coercion, and if it does not reach a total understanding or total absence of influences. The autonomy of a person is respected when the right to maintain points of view, to make choices and to carry out actions based on personal values and beliefs is recognized. Respect for the patient’s autonomy forces professionals to reveal information, to ensure understanding and voluntariness and to enhance the patient participation in decision making.

Regarding the principle of non-maleficence, reference is made to the obligation not to violate intentionally. This principle is inscribed in the tradition of the classic maximum primum non nocere ("the first not damage"). Although the maximum as such is not found in hypocratic treaties, there is an obligation of non -maleficence expressed in the Hippocratic oath.

Some philosophers consider non-maleficence and charity as the same principle. For Beauchamp and Childress, the obligation not to harm others, for example, not steal, not hurt or not to kill, is clearly different from the obligation to help others, for example, offer benefits, protect interest or promote well -being.

This principle requests "not damaging". One person damages another when he injures the interests of this. These interests can be: reputation, property, privacy or freedom. The authors referring to the principle of non-maleficence are concentrated in "physical damage, including pain, disability and death, without denying the importance of mental damage and injuries to other interests". This is, in my opinion, also an ethic that we could call

In conclusion of the above, it is possible to understand the work of Beauchamp and Childress as one of the icons of global ethics where starting from the principle theory, they propose the formal proposal, on the principles or duties of medical ethics that continue in force.

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