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Why the Topic of Bioethics in Science Classes?

A New Look at an Old Debate

by Carolyn Csongradi

What Are The Origins For The Principles Guiding Physicians?

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 containment process.

Teaching Moral Problem Solving Continued:

Factors Influencing The Way Decisions Are Made

Additional Sources of Information

Bioethics in Science Index

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