The principle of “do no harm” in the history of medicine. The principle of "double effect"
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The principle of “prima non nocere” (“first of all, do no harm”) is the oldest in medical ethics. It is often combined with the principle of beneficence. However, the prohibition to do evil and the incentive to create good carry different meanings. The principle of non-harm prescribes the duty not to cause harm to the patient, not only directly, intentionally, but also indirectly. To implement this principle and reduce harm or side effects, four requirements are proposed:
1. What we intend to do must not be immoral and must not be evil.
2. The intended risk should not be a means to achieve a good end. The planned action may have side effects, but this does not mean that the good end justifies any means. You cannot do something immoral just because something positive might follow.
3. By-effect should not be a special goal, but only something that one has to come to terms with.
4. To perform an action that may entail Negative consequences, there must be good reasons. This means that the possible benefit must be weighed against the risk, and the benefit must outweigh the risk.
If you approach the situation from the doctor’s perspective, you can distinguish the following forms of “harm”:
· harm caused by inaction, failure to provide assistance to those who need it;
· harm caused by negligence or malicious intent, for example, selfish purpose;
· harm caused by incorrect, thoughtless or unskilled actions;
· harm caused by actions that are objectively necessary in a given situation.
The harm that a doctor’s actions can cause to a patient can be intentional or unintentional. We can talk about intentional harm both in cases of criminal (with malicious intent) causing harm, and when, for medical reasons, the harm is objectively necessary (inevitable). It can be foreseen in advance and its possible scale can be assessed. But often people, including doctors, cause unintentional harm through their actions. If you look at the situation from the patient's side, you can see the most different types harm.
A visit to a doctor itself requires spending time (and now often money), which the patient could devote to something else, more pleasant for him, or vice versa: because of the visit to the doctor, he was unable to do some other important things for him. yourself. And if, say, a doctor prescribes a certain regimen for a patient, then the harm is expressed in some (sometimes very significant) limitation of the patient’s capabilities, his freedom; In the case of hospitalization, the harm associated with disability becomes especially significant.
Another form of harm relates to informing the patient about his condition and his prognosis. In this case, harm can be caused in connection with withholding information, deceiving the patient, as well as telling him truthful information. On the one hand, by deceiving someone, we in ourselves harm him, since we humiliate his dignity; In addition, a person who does something based on insufficient or incorrect information may unwittingly cause harm to himself and others. On the other hand, harm can also be caused if the patient is given truthful but discouraging information about the state of his health, especially when this is done in cruel forms, without taking into account his emotional state.
Harm to the patient may also arise from the fact that a doctor or any other employee of a medical institution discloses medical information about this patient to third parties (violates the rule of confidentiality). In general, the disclosure of this information is a violation of the law protecting medical confidentiality, and in such cases we cannot say that this harm is inevitable. But even in those situations where the law allows or even requires the disclosure of this information (but only to a strictly defined circle of people!), harm may nevertheless be caused to the patient (which now turns out to be inevitable), even if it was thereby prevented the danger of harming others by infecting them. In this case, as in the case of deceiving a patient, we are talking about causing him not physical, but moral harm.
Further. Treatment prescribed by your doctor may include painful procedures. It turns out that the doctor (of course, with a good purpose - to cure the disease) causes physical suffering to the patient. And in certain situations, the doctor faces the need to inflict more serious damage, say, to amputate an organ, which will make the patient disabled.
Finally, the already known option is also possible, when the patient suffers from a fatal, incurable illness, which is also accompanied by severe pain. In this case, the patient may decide that a quick and painless death will pose less harm to him than the continuation of severe and hopeless torment.
Unlike the other types of harm we listed earlier, which can and should be avoided, in this case we are talking about harm that is inevitable as long as it is assumed that the patient will receive some benefit from the doctor. Firstly, it is important that the harm caused does not exceed the benefit that is acquired as a result of medical intervention, and, secondly, that with the chosen course of action this harm itself is minimal compared to all others possible options.
Thus, the principle of “do no harm” should be understood in the sense that the harm emanating from the doctor should only be harm that is objectively inevitable and minimal.
This principle is the oldest in medical ethics. In Latin it sounds “primum non nocere”: “above all, do no harm.” The words “first of all” can be interpreted to mean that this principle is the most important in the work of a doctor. The principle of “do no harm” is usually seen as the essence of Hippocratic medical ethics. The Hippocratic Oath says: “I will direct the treatment of the sick to their benefit according to my strength and my understanding, refraining from causing any harm and injustice."
What exactly is meant by harm in relation to the activities of a doctor? If we approach the “doctor-patient” situation from the doctor's side The following forms of harm can be distinguished:
1) harm caused by inaction, that is, failure to provide assistance to those who need it;
2) harm caused by dishonesty, malicious or selfish intent;
3) harm caused by incorrect or unskilled actions.
The first type of harm is failure to provide assistance- in some cases may be an offense, that is, failure to fulfill such an obligation as is imposed by law or regulatory documents. Therefore, in such situations the problem is not only moral, but also legal. A doctor who is on duty and does not perform the actions that he must carry out in relation to a given patient will be responsible, firstly, due to failure to fulfill his duties and, secondly, depending on the consequences that his inaction entailed. Moreover, if under the first circumstance liability is unconditional, then under the second it may be justified to some extent: for example, if the doctor had to spend time helping another patient who was in a more serious condition. However, the patient who was not provided with assistance, or his relatives, can present claims to the doctor, including a lawsuit.
Let us assume that the doctor is not on duty. On a train or plane, there is a need for emergency medical intervention, and the crew turns to the passengers: “If there is a doctor among you, we ask him to help.” In this situation, a doctor who is among the passengers may not come to the rescue. Bringing him to criminal responsibility, even if others somehow find out about his profession, will not be easy. According to American laws, for example, a doctor practicing private practice, in such a case is not subject to legal liability. However, from a moral perspective, such inaction is clearly reprehensible. For example, the professional association of American doctors may deprive the doctor who committed this act of a license giving the right to practice medicine.
The second type of harm is damage caused by dishonesty, that is, improper performance of one’s duties. Whether the doctor was too lazy to perform any required procedure or did not perform it intentionally, in all cases we can talk about administrative or legal responsibility along with moral condemnation.
The third type of harm is harm caused by insufficient qualifications, that is, the doctor’s inability to perform his duties efficiently. The concept of “doctor’s qualifications” thus has not only technical, but also moral content. A person, having become a doctor, is morally obliged to be able to do what a doctor should do. Moreover, he is morally obliged to be able to do everything that belongs to the cutting edge of medical practice today.
Looking at the doctor-patient situation from the patient's side, other types of harm can be seen.
Thus, harm to the patient can be associated, for example, both with the concealment of information by the doctor, that is, with the deception of the patient, and with the communication of truthful information to him. On the one hand, by deceiving someone, we harm him because we humiliate his dignity, not to mention the fact that a person who does something based on insufficient or incorrect information can cause harm to himself or others. But harm can also be caused if the patient is given truthful but discouraging information about the state of his health, especially when this is done in cruel forms, without taking into account his mental state.
Harm to a patient may result from the fact that a doctor - or any other employee of a medical institution - discloses medical information about a given patient to third parties, thereby violating the rule of confidentiality. Disclosure of this information is a violation of laws protecting medical confidentiality. However, in some situations, the law allows or even requires the disclosure of this information, but only to a strictly defined circle of people. The patient is harmed in order to prevent the risk of harm to other people, for example, through infection. Note that in this case, as in the case of deceiving a patient, we are talking about harm to him not physical, but moral harm. When talking about the relationship between doctor and patient, it is necessary to keep in mind both of these categories of harm.
All of the above types of harm can and should be avoided. However, if the principle of “first, do no harm” is interpreted literally, that is, in the sense of avoiding any harm at all, including any pain and any restrictions, then the doctor would be forced to refuse any intervention. The doctor inflicts pain and imposes restrictions only because it is assumed that the patient will receive from the doctor a benefit that exceeds the pain and restrictions. It is important here, firstly, that the suffering caused to the patient does not exceed the benefit that is acquired as a result of the medical intervention, and, secondly, that with the course of action chosen by the doctor, this suffering is minimal. Thus, the patient's suffering emanating from the doctor should only be objectively inevitable and minimal.
We can talk about intentional harm to the patient in cases of inaction, intentional causing harm and objectively inevitable harm caused by the doctor. The latter type of harm can be foreseen and its possible consequences can be assessed in advance. Sometimes doctors also cause unintentional harm through their actions. Here, accordingly, two options are possible: when harm to the patient occurred due to an unwillingness to think about possible consequences and when it stems from external circumstances beyond the doctor’s control. Moral and legal responsibility is distributed according to the causes of unintentional harm.
THE PRINCIPLE OF “DOUBLE EFFECT” was developed in Roman Catholic theology. Is traditional method checking whether the risk is justified. It says: “Only such an action should be performed if it is intended to produce a good result, and the bad one will be an unintended or side effect.” More precisely, 4 conditions must be satisfied:
1. The action itself must be in morally good or at least morally indifferent. (That is, the action we intend to perform must not be evil or unfair).
2. The harm that we take into account should not be the means by which a good result is achieved.
3. The motive should be to achieve only a good result. That is, an evil or harmful consequence cannot be intentional, but only possible and tolerable.
4. There must be a proportionate reason to carry out an action, despite the consequences that the action itself brings.
In a medical context, the principle of double effect is most often mentioned in cases of abortion. But in biomedical ethics it has, in fact, a much wider scope. It is used in cases of contraception, sterilization, organ transplantation, as well as in cases of the use of extraordinary means to maintain life.
Home > Working programm9. Test tasks
1. The term “ethics” is mentioned for the first time in the work
a) Epicurus
b) Plato
c) Aristotle
d) Socrates
2. Axiology is...
a) the doctrine of being;
b) teaching about values;
c) the doctrine of knowledge;
d) the concept of morality;
d) the doctrine of man.
3. Professional ethics- This:
a) teaching about values;
b) general theory morality;
c) the doctrine of duty;
d) the doctrine of norms of behavior;
D) the doctrine of professional morality.
4. Morality is:
a) stable, stereotypical methods of mass behavior that have developed historically;
b) a form of social consciousness, a method of normative regulation of social relations and human behavior;
c) a set of norms and rules of behavior of people, approved by the state and mandatory for all members of society;
d) rules of etiquette;
e) a set of customs and traditions.
5. The characteristics of moral standards are:
a) generality and universality;
b) rationality and objectivity;
c) relativity, convention;
d) humanism, tolerance;
e) truth and scientificity.
6. The object of social work ethics is:
a) professional morality of specialists;
b) legal relations social worker and client;
V) moral values society;
d) codes of ethics;
e) regulations and job descriptions.
7. The purpose of social work ethics is:
a) maintaining legal relations between the social worker and the client;
b) assessment of the prevailing morality and value system in society;
c) analysis of the ethical needs of the specialist and the client;
d) ensuring and maintaining the content and goals of the profession;
d) all of the above.
8. The preventive function of social work ethics is to:
a) satisfying the interests of the social service client;
b) education and improvement of the personality of the social worker and the client;
c) the formation of socially and professionally approved motives for activity;
d) preventing behavior and actions that are harmful to the client and society;
e) increasing the status of the social worker profession in society.
9. Professional morality in social work is:
A) quality characteristic relationship between social worker and client;
b) a set of ideals and values, ethical principles and norms that reflect the essence of the profession;
c) a set of personal qualities of a specialist;
d) a set of goals and performance results;
e) the totality of ethical needs of social workers.
10. The “external” level of social work ethics involves evaluation
a) social work as a social institution;
b) the activities of a social worker;
c) activities of social services;
d) social worker-client relationship;
e) relations between a social worker and a social worker.
11. The main ethical values of social work are:
a) moral values of the client;
b) human well-being, social justice and individual dignity;
c) the values of the client and social group;
d) moral values of social workers;
d) material resources and resources.
12. From the point of view of the naturalistic approach, morality is
a) this is the result of the socio-historical development of mankind;
b) it is the result of biological evolution;
c) is a manifestation of superhuman, supernatural consciousness;
d) has an a priori character;
e) is an expression of human will.
13. What is the name of the moral principle, which is expressed in the fact that moral standards are given a relative, completely conditional and changeable character?
a) rationalism;
b) absolutism;
c) relativism;
d) dualism;
e) eudaimonism.
14. How is “ Golden Rule"morality?
a) love your neighbor as yourself;
b) do not kill;
c) do not steal;
d) treat others as you would like them to treat you;
e) an eye for an eye, a tooth for a tooth.
15. From the point of view of hedonism, the highest good and criterion of behavior is
a) happiness;
b) benefit;
c) pleasure;
d) suppression of sensual desires;
d) knowledge of the truth.
16. What is the name of the moral position, according to which each person should perform selfless actions aimed at the benefit (satisfying the interests) of another person?
a) altruism;
b) selfishness;
c) rationalism;
d) voluntarism;
d) idealism.
17. The basic principle of Christian ethics is:
a) reverence for life;
b) serenity and equanimity;
c) the principle of benefit;
d) mercy and compassion;
d) justice.
18. Which ethical concept denies the absolute nature of morality?
a) “reasonable egoism”;
b) stoicism;
c) eastern religions;
d) Christianity;
e) Kant's concept.
19. “Domostroy”, as a secular code of ethics, extends to Rus' in
20. In what religious direction is poverty considered one of the most godly deeds?
a) in Catholicism;
b) in Orthodoxy;
c) in Islam;
d) in Buddhism;
d) in Protestantism.
21. Which Russian philosopher believed that the main moral commandment is non-resistance to evil?
a) L. Tolstoy;
b) V. Soloviev;
c) I. Ilyin;
d) N. Berdyaev;
e) S. Frank.
22. In which religious direction does honest work as “worldly asceticism” act as an ethical ideal?
a) in Islam;
b) in Judaism;
c) in Orthodoxy;
d) in Buddhism;
d) in Protestantism.
23. What is the name of the direction in ethics that considers benefit the basis of morality and the criterion of human actions?
a) eudaimonism;
b) utilitarianism;
c) hedonism;
d) deontological ethics;
d) determinism.
a) Spinoza;
d) V. Soloviev;
e) F. Dostoevsky.
25. The term “altruism” was introduced into scientific use
a) I. Bentham;
b) Feuerbach;
c) Kant;
d) Epicurus;
a) M. Luther;
b) M. Weber;
c) G. Spencer;
d) N. Berdyaev;
e) I. Bentham.
27. Which philosopher believed that the main ethical principle is the principle of “reverence for life”?
c) A. Schweitzer;
d) V. Soloviev;
d) Shaftesbury.
28. Humanism as a cultural movement arises during the period
b) XIV-XVI centuries;
c) XVII-XIX centuries;
e) XIX-XX centuries.
29. The founder of utilitarianism is
a) T. Hobbes;
c) J. Locke;
d) J. Dewey;
e) I. Bentham.
30. The main criteria of morality in social work are:
a) promoting social progress, social expediency and cooperation;
b) respecting the interests of the client;
c) respecting the interests of the professional group;
d) rationality and objectivity;
d) conscience and tact.
31. The basic principles of social work ethics are:
a) empathy and sympathy;
b) objectivity, expertise, innovation, etc.;
c) confidentiality, goodwill, responsibility, etc.;
d) subjectivism and relativism;
e) principle creative approach to activity.
32. The ideal in social work is:
a) an idea of the perfect state of a specialist, client, social worker;
b) the subject of the professional code of ethics;
c) deontological criterion;
d) direction of activity of the social service;
e) criterion of morality.
33. The ethical consciousness of a social worker presupposes the presence and combination of:
a) the moral knowledge of the social worker and the needs of society;
b) moral knowledge, moral beliefs and moral needs;
c) the moral needs of the social worker and the needs of the client;
d) the personal beliefs of the specialist and the client’s values;
e) moral knowledge of the social worker and the needs of the client.
34. Moral standards in social work it is:
a) rules of etiquette;
b) general values of social work;
d) characteristics of the specialist’s personality orientation;
e) ethical beliefs of a specialist.
35. The professional and ethical code of social work is:
a) a system of values and ideals modern society;
b) the main component of the ethical consciousness of a specialist;
c) a set of personal values of social workers;
d) a set of value guidelines;
e) a set of ethical rules and norms of behavior, requirements for the personality of a specialist;
36. The professional and ethical code of social workers in Russia was adopted in
37. The International Declaration of Ethical Principles for Social Work and the International Ethical Standards for Social Work were adopted by IFAD in
38. The International Ethical Standards for Social Work contain
a) 5 groups of standards;
b) 6 groups of standards;
c) 4 groups of standards;
d) 8 groups of standards;
e) 10 groups of standards.
39. Confidentiality in social work is:
a) performance efficiency criterion;
b) the principle of an objective approach to activity;
c) professionally significant quality of a specialist’s personality;
d) rules of etiquette;
e) the principle of cooperation between the social worker and the client;
40. The deontology of social work is:
a) teaching about professional values;
b) the doctrine of proper behavior of a specialist;
c) a set of requirements for results professional activity;
d) the doctrine of the personal qualities of a specialist;
e) the doctrine of morality.
41. The term “deontology” was introduced into scientific use by:
a) O. Comte;
b) Socrates;
c) I. Bentham;
d) I. Kant
d) Hippocrates.
a) ethical knowledge and ethical actions;
b) good and evil;
c) morality and spirituality;
d) professional duty and responsibility;
e) justice and humanism.
43. The formulation of the principle “do no harm” presumably belongs to
a) Abu Ali ibn Sine;
b) Hippocrates;
c) Aesculapius;
d) Epicurus;
d) Socrates.
44. Which of the following principles is not a principle of social work deontology?
a) the principle of personal responsibility for the assigned work, both legally and morally;
b) the principle of specialist competence;
c) the principle of utilitarianism;
d) the principle of correspondence of powers and responsibilities;
e) the principle of organization and discipline.
45. The ethical principles of research in social work are:
a) voluntary participation, complete information about the progress and results of the study, etc.;
b) non-violence, solidarity, etc.;
c) support for general welfare, willingness to transfer knowledge to others;
d) compassion and mercy;
e) taking into account the interests of individuals social groups.
46. Professional and ethical regulation in the field of social work presupposes:
a) development ethical codes;
b) development and maintenance job descriptions;
c) development of additional regulations;
d) formation of the intellectual potential of social work;
e) formation of the client’s value system.
47. From what positions can a social worker act in relation to a client:
a) the interests of an individual client exceed the interests of society;
b) the interests of the state and society exceed the interests of the social service client;
c) the interests of the client and the interests of society must be harmoniously combined;
d) the interests of a professional group of social workers are higher than the interests of the client and society;
e) the personal interests of the social worker are higher than the interests of the client and society.
48. The need for ethical and axiological regulation of the behavior and activities of a social worker is determined by
a) imperfection of the regulatory framework;
b) innovativeness of social work as a type of activity;
c) the specific meaning and content of the activity;
d) dehumanization of human relations;
c) the popularity of the desire to achieve personal gain.
49. The etiquette of a social worker is:
a) a set of customs and traditions of social work;
b) a set of requirements for external forms of behavior and communication of a specialist;
c) the totality of ethical knowledge of a specialist;
d) a set of requirements for personal qualities specialist;
e) social work value system.
50. Which of the following principles is not a principle of etiquette for a social worker?
a) the principle of expediency of actions;
b) the principle of humanism;
c) accounting principle folk traditions and customs;
d) the principle of aesthetic attractiveness of behavior;
e) the principle of individualism.
Test answers:
1-in; 2-b; 3-d; 4-b; 5-a;6-a; 7-g; 8-g; 9-b; 10-a; 11-b; 12-b; 13-v; 14-g; 15-v; 16-a; 17-g; 18-a; 19-v; 20-b; 21-a; 22-d; 23-b; 24-g; 25-d; 26-b; 27-v; 28-b; 29-d; 30-a; 31-v; 32-a; 33-b; 34-v; 35-d; 36-g; 37-v; 38-a; 39-d; 40-b; 41-v; 42-g; 43-b; 44-v; 45-a; 46-a; 47-v; 48-v; 49-b; 50-d.
List of textbooks and teaching aids, available in the educational subscription of KSMU in the department of history, philosophy, sociology and political science
| Number of copies | ||||
| Medvedeva, Galina Pavlovna. Ethics of social work: Textbook. allowance / G. P. Medvedeva. - M.: Humanite. ed. VLADOS center: Moscow. state social univ., 1999. - 206 p. 2002. - 206, p. | ||||
| Guseinov, Abdusalam Abdulkerimovich. Ethics: A Textbook for Higher Students. textbook Head / A. A. Guseinov, R. G. Apresyan. - M.: Gardariki, 1999. - 472 p. | ||||
| Zelenkova, Inessa Lvovna. Ethics: Textbook. manual and workshop / I.L. Zelenkova, E.V. Belyaeva. - 2nd ed., rev. and additional - Minsk: TetraSystems, 1998. - 367 p. | ||||
| Ethics of social work: Method. benefits for full-time and part-time students. Department of Faculty social work / Kazan. state honey. University, Dept. philosophy; Compiled by: F. T. Nezhmetdinova and others - Kazan: KSMU, 2002. - 54 p. | ||||
| Professional and ethical foundations of social work: educational method. benefits for full-time and part-time students. forms of teaching social works / Feder. health and social agency Development of the Russian Federation, State Educational Institution of Higher Professional Education "Kazan State Medical University", Dept. history, philosophy, sociology and political science; [comp. M. E. Solovyanova]. - Kazan: KSMU, 2008. - 22 p. Working programm The work program is compiled taking into account the requirements of the State Educational Standard of Higher Education vocational education For medical specialties and 040101 – social work, in accordance with the curriculum. |
The literature on bioethics suggests various options systematization of universal principles and norms of biomedical ethics. The most widely recognized concept was proposed by famous American specialists Tom Beachamp and James Childress in their work “Principles of Biomedical Ethics.” The authors highlight the following principles:
· The principle of “do no harm” (Hippocratic model);
· The principle of “do good” (Paracelsus model);
· The principle of “observance of duty” (deontological model);
· The principle of justice;
· The principle of respect for human rights and dignity
The principles of “do no harm” and “do good” have been the fundamental foundations of traditional medical ethics since the time of Hippocrates, and the principles of justice and respect for the rights and dignity of the individual have become relevant in modern times. modern stage development of biomedical ethics.
The principle of “do no harm” (Hippocratic Model) in the Latin wording it looks like “Primum non nocere!”, which means “First of all, do no harm!” This principle dates back to Hippocratic ethics and is considered the moral foundation of medicine. The principle implies the need to avoid harm that the doctor may cause to the patient. The causes of harm may be inaction and failure to provide assistance to those who need it; negligence and malice; accidental errors and rash or unqualified actions of the doctor. A doctor can also cause moral harm to a patient due to withholding information and deceiving the patient, disclosing medical confidentiality, rude and inattentive attitude, etc. Of course, a doctor’s moral duty is to exclude harm caused by these reasons from his practice. However, it should be noted that any medical intervention involves risks for the patient, and often it is impossible to completely avoid harm. Therefore, when deciding to carry out a therapeutic, diagnostic or prophylactic procedure, the doctor must constantly weigh the benefits and risks associated with a particular intervention. It is important here, firstly, that the harm caused does not exceed the benefit that is acquired as a result of medical intervention, and, secondly, that with the chosen course of action this harm itself is minimal compared to all other possible options.
The principle of “do good” (Paracelsus model) requires active actions aimed at preserving life and restoring health, alleviating pain and suffering of the patient. Unlike the principle of “do no harm,” these actions involve not so much rational considerations, but rather feelings and emotions such as compassion and mercy. At the same time, the doctor is obliged to care not only about the welfare of the patient, but also about the welfare of society (for example, to fight the spread of epidemics), as well as the benefit of science, without which the progress of medicine is impossible. Difficulties arise when contradictions between these types of goods are revealed. From the position of modern biomedical ethics, the interest of science should not prevail over the interests of a particular individual. However, in exceptional cases it is considered morally justifiable to restrict the freedoms of an individual for the benefit of society. The “Paracelsus model” is a form of interaction between a medical worker and a patient and his relatives, in which the moral relationship between them is one of the main elements of therapy. In the Paracelsian model, taking into account the individual personal characteristics of the patient and establishing a trusting relationship between the doctor (and other medical professionals) and the patient are of key importance.
The principle of “observance of duty” (deontological model). He entered medical ethics along with the doctrine of the professional duty of medical workers. According to this principle, the health worker must strictly follow the prescribed medical ethics norms and rules and, in accordance with them, their professional responsibilities. The requirements of professional duty are strictly fulfilled. In accordance with this principle, it becomes a professional duty for a medical worker to follow the principles of “do no harm,” “do good,” and other ethical principles and norms. Violation of the requirements of professional duty entails certain penalties (moral, administrative, legal).
Principle of justice at the level of the doctor-patient relationship, it involves providing assistance to the patient regardless of his gender, age, race and nationality, social and financial status, political beliefs and religion, or personal preferences of the doctor; at the level of the healthcare system as a whole - equal access of all groups of the population to receive biomedical services and benefits, availability of pharmacological agents, protection of the most vulnerable segments of the population. When distributing scarce healthcare resources, one has to turn to certain criteria of justice - equality, taking into account individual needs or merits, etc. Of course, none of them can be considered absolute and often several criteria are used to distribute limited medical resources.
The principle of respect for the rights and dignity of the individual is based on the recognition of a person as an unconditional value and presupposes the free choice of an individual in relation to his life and health (choice of a medical institution, attending physician, consent or refusal of treatment, etc.). At the same time, the choice that the patient makes, no matter how much it diverges from the doctor’s position, should determine further actions the last one. This principle is leading in bioethics, as it allows the patient to realize the rights of the patient in relation to his life and health to the greatest extent.
In addition to the above principles, one can also note:
The principle of respect for human dignity , implying recognition of the intrinsic value of each individual, including people who, due to their physical or mental state do not have the opportunity to express their will;
The principle of integrity, which focuses on the physical and mental identity of the individual with himself and prohibits the manipulation or destruction of this identity;
The principle of vulnerability , characterizing the fragility and finitude of every life, and also requiring special protection and attention in relation to separate groups population (poor, illiterate, children, disabled).
In October 2005, the UNESCO General Conference adopted the Universal Declaration on Bioethics and Human Rights . The Declaration addresses ethical issues related to medicine, life sciences and related technologies, and sets out 15 principles to ensure respect for human dignity, human rights and fundamental freedoms in these areas.