A term that is sometimes used interchangeably with health care ethics is:

Clinical ethics is part of the broader discipline of bioethics.  It is a structured approach to ethical decision-making in medicine and is used to help guide choices about medical care.

Bioethics is the interdisciplinary study of ethical issues arising in the life sciences, health care, and health and science policy.

Clinical ethics can help to identify, understand and resolve ethical issues that arise in patient care by helping to clarify why certain actions are right or wrong.  Clinical ethics uses ethical reasoning and the application of bioethical principles to resolve ethics questions.

The Core Principles of Bioethics

• Beneficence: duty to help the patient advance their own good and to act in a patient’s best interest
• Autonomy: duty to honor a patients right to make their own decision and to be self-determining
• Nonmaleficence: duty to do no harm to the patient
• Justice: duty to be fair in how care is provided and in how resources are allocated

No single principle trumps the others; their relationship is dynamic and requires clinicians to carefully evaluate each situation on its own merits and patient needs.

The Difference between Morals and Ethics

These terms are often used interchangeably to refer to what is considered right or wrong. But they are not exactly the same.

• Morals refers to generally accepted customs or practices that are based on common societal values and beliefs
• Ethics focuses on deliberation and explicit arguments to justify why actions are right or wrong

An Approach to Resolving Ethics Questions

Uncertainty is an inherent part of clinical medicine because there are often multiple courses of action available—each with its own set of risks, benefits and burdens. Clinical ethics is rarely just about figuring out if something is right or wrong.  Rather, it involves a deliberative process to figure out a better, more right, more reasonable, or possibly least bad option.

Absolutism � As a political theory, absolutism is typically a synonym for despotism. As an ethical theory, it can be contrasted with . An absolutist would assert that there is one correct approach to the moral life, across persons and cultures. (The term is rarely used other than pejoratively, either in political theory or ethical theory.) Absolute ethical dictates might be attributed by adherents to the (unequivocally revealed) will of God, the dictates of Nature (to the extent that's not redundant), or apprehension through .

Act deontology � Theory that deontological (i.e., non-consequentialist) principles are -- or should be -- applied by individuals to each unique circumstance. Situations are seen as too idiosyncratic, in general, to be subsumable under general rules. Contrast with .

Act utilitarianism � Theory that the principle of utility is -- or ought to be -- applied to particular acts in particular circumstances. An act utilitarian justifies actions simply by direct appeal to the principle of utility. Contrast with .

Altruism � Regard for others. As a theory of action, this can be descriptive (i.e., that people do, at least sometimes, appear to act in other than self-regarding ways). Or it can be a normative position about how people ought to behave (viz., at least sometimes, people should act in non-self-regarding ways). Contrast with .

Autonomy � The principle of respect for persons, and of individual self-determination consistent with that principle. As most commonly defined, autonomy points in the direction of personal liberty of action in accordance with a plan chosen only by oneself. In , which reconciles with some difficulty with our usual individualistic views, autonomy is fully realized only when one governs oneself in accordance with universally valid moral principles.

Beneficence � Moral principle that one should help others further their important and legitimate interests, either as those persons understand them (respecting ) or as we conceive them (). Under this principle, failure to increase the good of others when one is knowingly in a position to do so is morally wrong. Nonetheless, the principle is usually understood restrictively: in most theories, one is obligated to act to benefit others when one can do so with minimal risk, inconvenience or expense. (Formally, the principle or duty of beneficence corresponds to the virtue or human characteristic of benevolence; in common parlance, these terms are often used interchangeably.) See also .

Confidentiality � The principle that one should keep one's promises about information (re)disclosure. A subset of duties of .

Consequentialist theories � Generally, a normative approach to morality that views what should be done as determined by consequences. The most common ethical/philosophical expressions are utilitarianism in its various flavors (viz., and ). More rarely, consequentialist theories can be merely descriptive in character -- that is a view of how moraliity is derived, desirability issues aside. Also labeled . Compare with .

Deontological (non-consequentialist) theories � Generally, a normative stance that views what should be done as determined by fundamental principles that do not derive solely or even primarily from consequences. An act or rule is right insofar as it satisfies the demands of some over-riding (non-consequentialist) principle of moral duty. Deontologists sometimes stress that the value of actions lies more in motives than in consequences. Religious revelation ("divine command") is the historically common foundation for deontological moral principles: things are right or wrong if, and only if, commanded or forbidden by God. Natural law or human reason may also be cited as sources. For example, John Rawls� Theory of Justice articulates a deontological approach based on appeal to a , reached by rational participants under conditions of absolute and equality. Some philosophers (and many sociobiologists) take the position that deontological principles are simply those that have "tested out" as having good consequences over a long period, and are accordingly sanctioned by custom, religious practice, etc.

Duty � Action, or an act, that is due by moral or legal obligation. Rights, grounded in core ethical principles such as autonomy, beneficence/nonmaleficence and justice, create duties -- either of non-interference (for negative rights) or for provision of social goods (positive rights). Duty need not be grounded only in the strong language of rights. Day-to-day social interactions also give rise to notions of duty: promises create duties of fidelity, gifts create duties of gratitude, and so forth. Many moral philosophers have argued that participation in a political-social system creates a duty to abide by its laws and standards (but see ).

Facts and values � Bifurcation of the world into statements about what is (facts) and what ought to be (values). The division is by no means universally accepted; and those that accept the division are not necessarily in close agreement on the dividing line. One of the central controversies of moral philosophy is whether value judgements (including moral judgements) can ultimately be proved, verified or justified in terms of facts or rational reasoning.

Fidelity � The principle that one should keep one's promises.

Justice � Commonly described as fairness, but more closely aligned to the concept of "desert" (pronounced like, but not to be confused with, "dessert" of the ice-cream et al variety): One has acted justly toward a person when one gives that person what is due or owed, and therefor what is deserved. Common to all definitions of justice is the minimal principle that relevantly similar cases (persons) be treated alike. Unfortunately, the definition of "relevantly similar" is not always self-evident. Some of the most intractable questions about justice arise over how to specify and prioritize among the relevant characteristics by which people are to be considered equal or unequal. (Consider affirmative action.) Moreover, the principle of "treat equals equally" leaves unanswered the question of appropriate differences in treatment, when relevant dissimilarities are found to exist. The term "distributive justice" refers, more restrictively, to the distribution of social benefits and burdens; "retributive justice" applies to issues of correction and punishment; "procedural justice" refers to social processes (most familiarly, in the judicial system). of justice stress equal access to primary social goods; of justice give primacy to social and economic freedom; Marxist theories emphasize need ("to each according to his needs; from each according to his abilities"); are focused on criteria to maximize well-being; and so on.

Morality (ethics) � The science of human duty; the rules of human conduct. The function of morality is "to combat the deleterious consequences of human sympathies" (Beauchamp). Its aim is "to contribute to betterment -- or at least non-deterioration -- of the human predicament" (Warnock). "Ethics aims at discovering what are those other properties belonging to all things which are good" (Moore). Moral/ethical principles have the following characteristics, in most but not all formulations: They are (1) supremely authoritative or over-riding as a guide to action; (2) prescriptive, not merely descriptive; and (3) universalizable, to relevantly similar situations. (But see also , as regards the last of these.)

Nonmaleficence � Moral principle that one should refrain from harming others ("first, do no harm"). Compare with .

Paternalism � Stance that a person�s is justifiably restricted to prevent self-harm, or to promote that person�s own well-being. Paternalism is an inherently liberty-limiting principle. It is grounded in a theory of impairment, viz., that an individual lacks sufficient facts or mental capacity to make a sound choice. It is sometimes defended by a theory of future consent: viz., that the person whose liberty is circumscribed will (or, at least in principle, could) eventually agree that the restriction was desirable, given better facts or improved cognitive capacity in future.

Rights � That which is due to individuals, based on core ethical principles. Rights create parallel on the part of others, or on society as a whole. So-called negative rights are rights of non-interference (e.g., with one�s speech, conscience, associations), typically grounded in the principle of . Positive rights, by contrast, are rights of "recipience" (e.g., to education, health care), typically grounded in the principle of .

Rule deontology � Theory that non-consequentialist principles must be applied in the form of rules, and that such rules determine whether particular acts are right or wrong. Contrast with . See also , .

Rule utilitarianism � Theory that the principle of is (or ought to be) the source of rules of conduct, and that such rules determine whether particular acts are right or wrong. Rules justified by their general utilitarian consequences may nonetheless require actions that do not maximize utility in particular circumstances. The justification is that, despite such cases, overall utility is maximized by a rule-following system, compared to the alternative of having individuals decide on conduct in particular circumstances. Human beings have a notoriously difficult time being impartial about utility (or anything else) in matters involving their self-interest. Rules have the virtue of imposing a degree of "objectivity" by virtue of their inflexibility. Consistency requires that rules be applied in the same way to relevantly similar circumstances. Unfortunately, what is relevantly similar is not always clear. Contrast with . See also , .

Utilitarianism � A conception of the moral life in terms of means-to-ends reasoning. An act or rule is right insofar as it produces or leads to the maximization of good consequences (). See and .

Veracity � The principle that one should tell the truth ("honesty is the best policy").

Virtues � Positive ethical/character traits, such as benevolence, confidential-ness, fairness, faithfulness, gratefulness, non-deceptiveness (truthfulness), nonmalevolence. Virtues correspond to principles or duties: , , , , gratitude, non-deception (), , etc.

From: Reid Cushman �1998-2005. Comments and corrections are appreciated and may be directed to [email protected].

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