The four principles: Can they be measured and do they predict ethical decision making?

BMC Medical Ethics

Katie Page¹ 

[1] School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia

关键词: Analytic hierarchy process;    Medical ethics;    Hierarchies;    Ethical principles;   

Others  :  800046
DOI  :  10.1186/1472-6939-13-10

 received in 2012-01-22, accepted in 2012-05-20,  发布年份 2012

【 摘 要 】

Background

The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas.

Methods

The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants who then made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation.

Results

Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average, individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas.

Conclusions

People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed.

【 授权许可】

   
2012 Page; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Gillon R: Ethics needs principles - four can encompass the rest - and respect for autonomy should be first among equals. J Medl Ethics 2003, 29(5):307-312.
• [2]Beauchamp TL, Childress JF: Principles of biomedical ethics. 5th edition. New York: Oxford University Press; 2001.
• [3]Toulmin S: The tyranny of principles. Hastings Cent Rep 1981, 1(6):31-39.
• [4]Arras J: Getting down to cases: the revival of casuistry in bioethics. J Med Philos 1991, 16:29-51.
• [5]Saaty TL: The analytic hierarchy process: Planning, priority setting, resource allocation. Advanced book program. New York: McGraw-Hill; 1980.
• [6]Self DJ, Baldwin Jr DC, Wolinsky FD: Evaluation of teaching medical ethics by an assessment of moral reasoning. Med Educ 1992, 26:178-184.
• [7]Self DJ, Schrader DE, Baldwin Jr DC, Wolinsky FD: The moral development of medical students: A pilot study of the possible influence of medical education. Med Educ 1993, 27:26-34.
• [8]Price J, Price D, Williams G, Hoffenberg R: Changes in medical student attitudes as they progress through a medical course. J Med Ethics 1998, 24(2):110-117.
• [9]Bore M, Munro D, Kerridge I, Powis D: Selection of medical students according to their moral orientation. Med Educ 2005, 39(3):266-275.
• [10]Rezler AG, Lambert P, Obenshain SS, Schwartz RL, Gibson JM, Bennahum DA: Professional decisions and ethical values in medical and law students. Acad Med 1990, 65(9, Suppl):31-32.
• [11]Rezler AG, Schwartz RL, Obenshain SS, Lambert P, Gibson JM, Bennahum DA: Assessment of ethical decisions and values. Med Educ 1992, 26:7-16.
• [12]Herbert PC, Meslin EM, Dunn EV: Measuring the ethical sensitivity of medical students: A study at the University of Toronto. J Med Ethics 1992, 18:142-147.
• [13]Westin L, Nilstun T: Principles help to analyse but often give no solution - secondary prevention after a cardiac event. Health Care Anal 2006, 14(2):111-117.
• [14]Waltho S: Response to Westin and Nilstun. Health Care Anal 2006, 14(2):119-122.
• [15]Landau R, Osmo R: Professional and personal ethical principles. Int J Soc Welf 2003, 12:42-49.
• [16]Smith CM: Origin and uses of Primum Non Nocere: Above all, do no harm! J Clin Pharmacol 2005, 45:371-377.
• [17]Gillon R: Medical ethics: Four principles plus attention to scope. Brit Med J 1994, 309(5):184-188.
• [18]Dawson A, Garrard E: In defence of moral imperialism: four equal and universal prima facie principles. J Med Ethics 2006, 32:200-204.
• [19]Vaidya O, Kumar S: Analytic hierarchy process: An overview of applications. Eur J Oper Res 2006, 169:1-29.
• [20]Barbarosoglu G, Pinhas D: Capital rationing in the public sector using the analytic hierarchy process. The Engineering Economist 1995, 40(4):315-341.
• [21]Lee H, Kwak W, Han I: Developing a business performance evaluation system: An analytic hierarchical model. The Engineering Economist 1995, 40(4):343-357.
• [22]Mustafa MA, Al-Bahar JF: Project risk assessment using the analytic hierarchy process. IEEE T Eng Manage 1991, 38:46-52.
• [23]Yau C, Davis T: Using Analytic Hierarchy Process (AHP) to prioritize auditing tasks for large-scale software systems. J Syst Manage 1993, 44(11):26-31.
• [24]Gillon R: Four scenarios. J Med Ethics 2003, 29(5):267-268.
• [25]Triandis HC: Values, attitudes, and interpersonal behavior. In Nebraska Symposium on Motivation: 1979. Edited by Howe HE, Page MM. Lincoln, Nebraska: University of Nebraska Press; 1980:195-259.
• [26]Blondeau D, Godin G, Gagnea C, Martineau I: Do ethical principles explain moral norm? A test for consent to organ donation. J Appl Biobehav Res 2004, 9(4):230-243.
• [27]Godin G, Naccache H, Morel S, Ébacher M: Determinants of nurses’ adherence to universal precautions for venipunctures. Am J Infect Control 2000, 28(5):359-364.
• [28]Bélanger D, Godin G, Alary M, Noél L, Côté N, Claessens C: Prediction of Needle Sharing Among Injection Drug Users1. J Appl Soc Psychol 2002, 32(7):1361-1378.
• [29]DeMarco J: Principlism and moral dilemmas: a new principle. J Med Ethics 2005, 31(2):101-105.
• [30]Kuczewski M: Casuistry and principlism: the convergence of method in biomedical ethics. Theor Med Bioeth 1998, 19(6):509-524.