Chapter 5 of medical ethics: medical moral principles

Section 2 Principles of Medical Ethics

The principle of medical ethics is an important part of medical ethics system.

First, the principle of doing good.

The principle of doing good is the fundamental norm and principle of medical ethics.

(1) An overview of the principle of doing good.

The so-called principle of doing good is to require the medical behavior of the medical profession to conform to the purpose of good medical ethics.

(B) the relationship between the principle of doing good and the purpose of medical ethics

The principle of doing good is the general principle and purpose of medical ethics, that is, the ultimate standard of medical ethics. There are both connections and differences between them.

1, the relationship between them

2, the difference between the two

The significance of following the principle of doing good

The principle of doing good adjusts all ethical relations caused by medical behavior in the whole medical field. It is a universal and fundamental moral principle of medical ethics, with comprehensive jurisdiction, consistent implementation and comprehensive outline, and other principles are its derivatives and extensions.

Second, the principle of superiority.

Beneficial principle is an ancient medical ethical principle. Some people think that the principle of doing good is beneficial. We believe that the benefit principle is only one aspect of the principle of doing good-how to treat the parties well is the extension and derivative of the principle of doing good.

(A) Overview of favorable principles

The so-called favorable principle is to require the medical industry to implement favorable medical behaviors for the parties.

(B) the significance of following the favorable principle

Beneficial principle is the first principle of treating patients well, and it becomes the premise and basis of other ethical principles of how to treat patients.

Third, the principle of no harm.

The basic moral principle of how to treat patients in the medical field is the principle of interest, but there is another aspect of this requirement, that is, the principle of no harm. The principle of no harm is also an ancient medical ethical principle. With the development of medicine and the deepening of people's understanding, people pay more and more attention to it.

(a) Overview of the principle of no harm

The so-called principle of no harm, also known as the principle of no harm, requires the medical industry to minimize the harm to the parties.

(b) Significance of following the principle of no harm

Like the beneficial principle, the harmless principle is another aspect of the moral principle of treating patients well, and it has also become the premise and foundation of other ethical principles on how to treat patients.

Fourth, the principle of justice.

The principle of doing good requires equal and reasonable distribution of health resources, so that every public can get equal and reasonable medical care, which is the requirement of the principle of justice.

(A) an overview of the principle of justice

The so-called principle of justice requires the medical community to allocate health resources equally and reasonably.

1, justice in the general sense

(1) The meaning of justice. Justice in the general sense is "the act of equal benefit (harm) exchange", and "equal benefit (harm) exchange" is the principle to measure whether all actions are fair.

(2) type. According to the object of fair behavior exchange, it can be divided into distribution justice and revenge justice: the former is equal interest exchange; The latter is equal harm exchange.

According to the nature of fair behavior, it can be divided into fundamental justice and non-fundamental justice: the former is the justice of the exchange of rights and obligations; The latter is the justice of the exchange of rights and obligations.

According to the nature of the actor, it can be divided into personal justice and social justice: the former is personal justice as the subject of the behavior; The latter is justice with society as the main body of behavior.

(3) the principle of justice. Because everyone's most basic contribution to society is completely equal-everyone is born as a shareholder who creates and concludes society-and should enjoy basic rights completely equally (basic rights are completely equal); Everyone should enjoy unequal non-basic rights because of the inequality of specific contributions, but the proportion should be completely equal (equal proportion of non-basic rights).

2, the principle of medical justice

(1) are completely equal. The right to health and medical care are basic human rights. According to the principle of "complete equality of basic rights", the right to medical care is completely equal in the field of primary health care, that is, "everyone enjoys primary health care".

(2) Reasonable differences, etc.

At present, people think that at least the following factors should be considered:

Quality of life, urgency of demand, social value, others.

(B) the significance of following the principle of justice

The principle of justice is the implementation of the principle of doing good in the medical field and the coordination of the relationship between the parties.

Verb (abbreviation of verb) the principle of human nature

(A) an overview of the principle of humanity

The so-called humanitarian principle, also known as medical humanitarian principle, requires medical personnel to respect, sympathize with, care for and help the clients.

(B) the significance of following the principle of humanity

The principle of humanity is the basic principle of medical ethics, which realizes the principle of doing good, being beneficial and being harmless in the most basic moral sense.

Sixth, the principle of rebirth

(A) Overview of the principle of rebirth

The so-called principle of rebirth requires the medical profession to cherish the life of the client.

Significance of following the principle of rebirth

The principle of rebirth is the basic principle of medical ethics and the basic requirement for medical profession, which realizes the principle of humanity in a more basic moral sense. The first requirement of humanitarianism is to cherish life-cherish and value human life, and on this basis, sympathize with, care for and help patients suffering from diseases.

Seven, the principle of autonomy

(A) Overview of the principle of autonomy

The so-called principle of autonomy requires the medical profession to respect the autonomy of the parties.

(B) the implementation of the principle of autonomy

The concept of autonomy has been deeply rooted in people's hearts, but it is very complicated to implement the principle of autonomy in reality.

1. Will respecting patients' autonomy reduce patients' enthusiasm and initiative?

We believe that respecting patients' autonomy does not reduce patients' enthusiasm and initiative, on the contrary, it puts forward higher requirements for medical staff: the asymmetry of medical information between doctors and patients determines that medical staff should respect patients' autonomy and should not do nothing, which requires providing sufficient conditions for patients' independent choice, that is, (1) explaining the patient's condition in detail; (2) Tell the patient what will happen with or without treatment; (3) Tell patients about various possible treatment schemes; (4) put forward the treatment plan that medical staff think; (5) Tell the patient the matters needing attention in the treatment plan to be implemented and how to cooperate with the treatment.

2. What if the "scheme" proposed by the medical staff is rejected by the patient?

(1) Determine whether the patient has the ability to make decisions independently.

(2) Follow the following principles: First, consider the wishes of the patient and his family members, who are closest to him. Such as spouse, parents, children, etc.

Secondly, in the case that patients have the ability to choose, and in the case that the opinions of patients and their families cannot be unified, we should emphasize the opinions of patients themselves.

Thirdly, when the patient does not have or loses the decision-making ability, the decision-making power is transferred to his family.

Finally, when the medical staff's plan is rejected by the patients and their families who have chosen by themselves normally, we should try our best to find out the real reason for the rejection, and then make a targeted explanation. If this effort fails, they should respect this choice and make a detailed and complete medical record.

3. Is the patient's autonomy absolute?

According to the medical ethics theory of public welfare theory, patients' autonomy is not absolute, but is based on the premise of not violating laws, regulations, policies, social public interests and morality. If the patient's autonomy conflicts with the above premise, we should not respect the patient's autonomy, but should reject the patient's "non-selectivity". If you have the right to refuse the birth request of patients who violate the family planning policy; Have the right to refuse the request for freedom of movement of patients with infectious diseases, and so on.

Eight. Principle of confidentiality

(1) Overview of confidentiality principle

The so-called confidentiality principle is to ask the medical profession to keep medical secrets, that is, to ask the medical profession not to disclose information that may cause adverse consequences in the work.

(two) the contents of keeping medical secrets.

1, information confidential to society and others.

(1) "patient" privacy

(2) National laws and other relevant regulations

2, confidential information to patients

(1) Some bad conditions and bad prognosis

(2) Fetal sex

(3) Information of hospitals and medical staff

(C) the significance of following the principle of confidentiality

The principle of confidentiality is a special requirement for the medical profession and a special implementation of the principles of doing good, beneficial, harmless and humane. The principle of confidentiality is stipulated by the laws of China, and it is the professional ethics of the international medical community at all times and at all times, the need to gain the trust and cooperation of patients, and the requirement of the protective medical system.

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The principles of medical ethics are interrelated.

In the whole medical moral principle system, the principle of doing good is a medical moral principle.

Beneficial principle, harmless principle and fair principle are the general principles of treating patients (clients) well.

Contradictions and conflicts often occur between medical moral principles. In the conflict of medical moral principles, the basic medical moral principles determine and produce other non-basic medical moral principles. On the one hand, there are conflicts between the basic medical moral principles and non-basic medical moral principles, so the basic medical moral principles should be considered first to coordinate their contradictions. On the other hand, through the basic medical moral principles, we can adjust the contradiction between nonexistent decisions and established medical moral principles.