Why the Topic of Bioethics in Science
A New Look at an Old Debate
by Carolyn Csongradi
What Are The Origins For The Principles Guiding
The origins of these four principles governing physician-patient
relationships can be traced initially to Hippocrates - the basis
of the Hippocractic oath. Early on, physicians were limited in
their skills and options in treating patients. The first premise
for the physician was to "do no harm" to the patient.
As medical knowledge advanced, the capacity to actually benefit
the patient became a reality. These two ideas formed the chief
guiding principles until the mid- twentieth century. Physicians
were largely torn between doing what was good for the patient
while balancing this against the risks of potential harm. For
instance, the administration of antibiotics may shorten the illness,
but carries with it the risk of developing resistant organisms.
There are trade-offs. If the benefits are minimal, then harmful
risks carry more weight.
Autonomy, which requires the patient be treated as a self-determining
agent, is related to informed consent and places the patient in
a collaborative role with the physician. This guiding principle
became more prominent after World War II and the atrocities documented
in the Nuremberg Trials.
Lastly, the principle of justice, viewed as one of equality, became a factor in
the early 1980s when changes in medical insurance plans were implemented.
The costs of medical malpractice and health insurance premiums
were climbing as physicians felt ever increasing pressure to perform
tests on patients to provide sufficient documentation for illness
or injury in the event of a lawsuit. To place a cap on medical
costs, a system of reimbursement was introduced by the federal
government. Hospitals were reimbursed for Medicare patients based
on average costs rather than actual expenses. This had the effect
of limiting the requests for expensive procedures as a cost
Teaching Moral Problem Solving Continued: