BOX 13 Areas of principle in the UNESCO bioethics core curriculum (2008)
1. Human dignity and human rights 2. Benefit and harm 3. Autonomy and individual responsibility 4. Consent 5. Persons without the capacity to consent 6. Respect for human vulnerability and personal integrity 7. Privacy and confidentiality 8. Equality, justice and equity 9. Non-discrimination and non-stigmatization 10. Respect for cultural diversity and pluralism 11. Solidarity and cooperation 12. Social responsibility and health 13. Sharing of benefits 14. Protecting future generations 15. Protection of the environment, the biosphere and biodiversity
Rather than providing the answers to what ethico-legal practice should be in given clinical context, like a list of instructions, principles signpost the respective interests represented in the situation (awareness) that are then to be balanced with each other when reaching ethical decisions (analysis). For example, a patient might require anti-hypertensive medication, which for his own reasons he wishes to decline, even though he understands the health risks of not receiving that form of treatment. Yet the doctor wishes his/her patient to benefit from the effective therapy readily available. The competing interests are beneficence and respect for the patient’s autonomy.
This calls for ethical reasoning that combines the personal, the legal, and the professional (Box 10). Given the patient’s decision-making capacity, his refusal of treatment is a clear entitlement protected by law. In personal terms, however, the doctor’s sense of duty regarding the patient’s health risks shapes the particular way he/she fulfils his or her ethico-legal obligations. For example, he/she may give additional attention to the non-pharmaceutical measures that the patient needs to follow in any case. Further, professional guidelines may set out standards of good practice in reaching therapeutic concordance whereby doctors are expected to provide patients with the opportunity to explore their concerns, should they desire this. In so doing, perhaps any objections to medication could be resolved there and then, or a misunderstanding clarified, or more adequate information given, or it might serve to facilitate revisiting the question sensitively on a future occasion, and potentially improve the possibility that the patient will be prepared at a later date to reconsider.
The approach to ethico-legal reasoning in the UNESCO core curriculum in bioethics sets out the four-step progression of fact deliberation, value deliberation, duty deliberation, and testing consistency (2008).
Professional guidelines may set out standards of good practice in reaching therapeutic concordance whereby doctors are expected to provide patients with the opportunity to explore their concerns, should they desire this.
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Guide 53: Ethics and Law in the Medical Curriculum
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