CAS PH 251 Lecture Notes - Lecture 6: Organ Transplantation, Dementia
2 May 2018
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Four Principles of Bioethics
The Four Principles
• There is no unified morality of what single consensus is most important
o Some principles downplay others while some support others
• Question: What is the relationship between principles and rules?
• Answer:
o Principles – framed in broad ways, are vague, must be filled out and cannot be
applied to action
▪ However, they give precedent to rules
o Rules – have more content, are derived from principles and can be applied to
actions in particular cases
• Prima Facie v. All-Things-Considered Obligations
o Prima Facie – things we see at an initial glance/reading
o All-Things-Considered – conclusions we arrive at after considering all possible
outcomes
The Four Principles
• 1. Respect for Autonomy
o Derivation: ‘Autos’ (self) + ‘Nomos’ (rule) = ‘Self-Rule’
o An agent acts autonomously only when they act:
▪ 1. Agency – acting intentionally (on beliefs/desires/rationality) + 2. with
understanding (regarding true beliefs)
▪ 3. Liberty – acting without coercion
o Autonomy admits in degrees, meaning that there are several variations and
outliers that are found in complex cases (ex: end-of-life cases such as dementia)
o Kant v. Mill – why is autonomy morally valuable?
▪ Kant assumes that rationality/capacity for reason is the only thing of
intrinsic moral value
▪ Mill believes that giving liberty to autonomy will help maximize utility
and create a flourishing society
• 2. Non-Maleficence
o Essentially means there is a duty not to inflict harm on others
o Medically: above all, do not make matters worse through biomedical intervention
• 3. Beneficence
o Essentially means that there is a moral duty to help/benefit others
o Obligation v. Charity
▪ Ongoing debate between individuals who ask how much we have to do to
help others
o Question: When does non-maleficence trump beneficence and vice versa? (ex:
organ transplant cases, vaccinations the harms are small compared to what
good will come out)
o Medically: beneficence is a primary goal
o Fiduciary Relationships
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