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BS MD: 3Y1-1
I. Basic Ethical Principles - Ethical principles provide a generalized framework within which ethical dilemmas may be
analyzed, these principles can provide guidance in resolving ethical issues that codes of ethics may not necessarily
provide. If basic moral teachings dont always provide obvious answers in the most unusual medical cases, they at least
orient us toward making ethical decisions based on a clear set of values.
a) Stewardship
This principle is grounded in the presupposition that God has absolute Dominion over creation, and that, insofar as human
beings are made in Gods image and likeness (Imago Dei), we have been given a limited dominion over creation and are
responsible for its care. The principle requires that the gifts of human life and its natural environment be used with profound
respect for their intrinsic ends. Accordingly, simply because something can be done does not necessarily mean that it should
be done (the fallacy of the technological imperative). As applied to Catholic-sponsored health care, the principle of
stewardship includes but is not reducible to concern for scarce resources; rather, it also implies a responsibility to see that
the mission of Catholic health care is carried out as ministry with its commitment to human dignity and the common good.
b) Totality
These principles dictate that the well-being of the whole person must be considered in deciding about any therapeutic
intervention or use of technology. Integrity refers to everyones duty to preserve a view of the whole human person in which
the values of the intellect, will, conscience, and fraternity are pre-eminent. Totality refers to the duty to preserve intact the
physical component of the integrated bodily and spiritual nature of human life, whereby every part of the human body exists
for the sake of the whole as the imperfect for the sake of the perfect.
c) Double Effect
An action that is good that has two effects--an intended and otherwise not reasonably attainable good effect, and an
unintended yet foreseen evil effectis licit, provided there is a due proportion between the intended good and the permitted
evil. When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether
the obligation to avoid evil requires one to abstain from good action to prevent a foreseen but merely permitted concomitant
evil effect. The answer is that one need not always abstain from a good action that has foreseen bad effects, depending on
certain moral criteria identified in the principle of double effect.
1. The object of the act must not be intrinsically contradictory to one's fundamental commitment to God and neighbor
(including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not
be intrinsically evil).
2. The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects
as far as possible, that is, one must only indirectly intend the harm.
3. The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other
means of achieving those effects are available.
4. The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate
judgment).
5. The beneficial effects must follow from the action at least as immediately as dote harmful effects.
d) Cooperation
Along with the principles of double effect and toleration, the principles of cooperation were developed in the Catholic moral
tradition as a way of helping individuals discern how to properly avoid, limit, or distance themselves from evil (especially
intrinsic evil) to avoid a worse evil or to achieve an important good. In more recent years, the principles of cooperation have
been applied to organizations or corporate persons (the implication being that organizations, like individual persons, are
moral agents). Like the principle of double effect and some other moral principles, the principles of cooperation are a
constellation of moral criteria:
1. Formal Cooperation.
Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares
in the agents intention, either for its own sake or to some other goal. Implicit formal cooperation occurs when, even though
the cooperator denies intending the object of the principal agent, the cooperating person or organization participates in the
action directly and in such a way that it could not be done without this participation. Formal cooperation in intrinsically evil
actions, either explicitly or implicitly, is morally illicit.
3. Principles of Justice
Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "Giving toeach that which is his due."
This implies the fair distribution of goods in society and requires that we look at the role of entitlement. The question of
distributive justice also seems to hinge on thefact that some goods and services are in short supply, there is not enough to
go around, thussome
fair means of allocating scarce resources must be determined.