Defense Date

9-14-2023

Graduation Date

Fall 12-15-2023

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Health Care Ethics

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Joris Gielen

Committee Member

Peter Ikechukwu Osuji

Committee Member

Peter I Osuji

Committee Member

Peter I Osuji

Keywords

Healthcare bioethics, Medical bioethics, Principlism, Bioethical principles, The ethical principle of Autonomy, The ethical principle of Beneficence, The ethical principle of Nonmaleficence, The ethical principle of Distributive Justice, Ethical decision making in healthcare, Resolving healthcare dilemmas

Abstract

Principlism is an ethical method that uses an analytical framework based on a set of principles that can function as guidelines for healthcare professionals. The term was made

famous by the work of two bioethicists, Tom L. Beauchamp and James F. Childress. Their book, Principles of Biomedical Ethics and its multiple editions described a set of norms that are basic

for biomedical ethics. The first edition of their book was published in 1979, and the ninth edition in 2019. Its persistence and durability speak for themselves. In addition, their writings made

famous the four bioethical principles of respect for Autonomy, Nonmaleficence, Beneficence, and Justice.

. The principle of Autonomy emphasizes that people should make decisions for themselves. Making a valid judgment includes determining the patient's capacity and the process involved when the patient lacks capacity. However, as discussed in the dissertation, the clinician's responsibility with this process is relevant to foster ethical and clinical reciprocity in resolving healthcare ethics dilemmas. The principle of Beneficence engages the concept of paternalism when healthcare professionals strive to do what is best for their patients. As discussed in the dissertation, ethical and clinical reciprocity must be maintained to balance patient Autonomy and provider

paternalism.

The principle of Nonmaleficence highlights the classical use of double-effect reasoning to enable healthcare professionals to resolve challenging scenarios. As discussed in the dissertation, this occurs by fostering ethical and clinical reciprocity in resolving healthcare ethics dilemmas.

The principle of Justice raises multiple issues that healthcare professionals must understand, such as inequities, vulnerability, and institutional responsibilities. The dissertation explains the need to foster ethical and clinical reciprocity in resolving these justice-related dilemmas. Finally, these

four principles often are applied to controversial situations via a healthcare ethics consultative service. The dissertation considers ethical and clinical reciprocity in resolving healthcare ethics dilemmas via such services.

This practical application of ethical principles to resolving dilemmas differs from the

approach of Albert Jonsen et al1., who situate ethical decisions within a broader approach of four quadrants: medical indications, preferences of patients, quality of life, and contextual features.

The broad nature of these quadrants can create a level of complexity that this dissertation seeks to avoid by a more straightforward approach of applying the four principles.

The dissertation is organized into eight chapters. The introductory chapter one presents an overview of the analysis. Chapter two presents the context of the dissertation by discussing the emergence of Principlism as a principle-centered approach to health care ethics. The following four chapters discuss the main principles of Principlism, applying them to foster ethical and

clinical reciprocity in resolving healthcare dilemmas. The applied topics are selected as

illustrative mainstream dilemmas that represent the extensive sweep of health care. Chapter three considers the principle of autonomy to enlighten widespread ethical dilemmas in clinical trials for late-stage cancers. Chapter four considers the principle of beneficence to address the

increasingly common ethical dilemma of medical futility in the intensive care unit.

Chapter five considers the principle of nonmaleficence to encourage a patient-centered palliative approach to end-of-life care. Chapter six considers the principle of justice to explain the need for the organization of health care to be undertaken as a sustainable resource. After

discussing these four principles in an applied manner, chapter seven embraces them

comprehensively to enhance the crucial role of ethics consultation services by fostering ethical and clinical reciprocity in resolving healthcare dilemmas. It is important to note that when these ethical principles are applied to practical dilemmas in healthcare, clinicians informally adopt the ethics consultation process described in the final chapter. By informally adopting the ethics consultation process, clinicians engage a preventive approach to address dilemmas early, thereby avoiding escalation to a more formal ethics consultation. Finally, chapter 8 provides a brief conclusion to the dissertation.

Language

English

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