Principlism
Ethical Decision Making in Health Care
The 4 Main Principles of Biomedical Ethics are:
1 • Respect for Autonomy
Respect for a person’s self-determined choice.
3 • Non-Maleficence
Decisions and actions do not harm the person.
2 • Beneficence
Decisions and actions are to benefit the person.
4 • Justice
fair, equitable, and appropriate treatment of the person.
As a healthcare professional you will encounter situations where the right course of action is not clear. Principlism is an ethical approach that can guide you through complex decision making in health care. Principlism uses four guiding principles that can support you in decision making in a way that balances the values of the patient with goals of care. Working through an ethical approach, such as principlism, can assist in decreasing moral distress by having a systematic way to support ethical decision making.
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Using principlism can assist in identifying what principles are in conflict. The next step is weighing and balancing which principles should be explored and be used to guide the care plan for the patient. If there continues to be conflict or the right course of action is not clear, you should consult the Health Care Ethics Service.
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Consideration when applying Principlism in patient care:
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Informed consent should be an ongoing process throughout a patient’s care.
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When patient competency is being considered as a barrier to decision making, capacity evaluations should be considered. Capacity is situation-specific and not always global to all decision making. Even patients with limited capacity should continue to be included in their care plan
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If a patient cannot communicate their wishes, do they have a health care proxy (HCP) or substitute decision maker (SDM)? Is the HCP/SDM making health decisions that are in line with the patient’s goals, values and religious beliefs?