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All of these principles require a conversation about the needs and desires of
the patient or, in the case of justice, members of community. The principles are
intended to guide.
Autonomy
We are required to determine the wishes of the patient in order to protect
his or her autonomy.
Case
An is 86-year-old female is informed that her leg is gangrenous
and that an amputation is necessary to save her life. She refuses
surgery, saying I am 86 and I have lived a good and full life. I do
not want a further operation, nor do I want to live legless. I
understand the consequence of refusing the amputation is death
and I accept that consequence. Is this patient competent to
decide to refuse the surgery?
Nonmaleficence
We are required to determine the patients views of what does and does
not count as goods to be pursued or harms to be avoided.
1. Do not kill.
2. Do not cause pain or suffering.
3. Do not incapacitate.
4. Do not cause offense.
5. Do not deprive others of the goods of life.
Case
A patient
with a long smoking history is hospitalized with advanced COPD and
lung cancer metastatic to bone. Consider the following scenario and
questions:
Beneficence
We are required to determine the patients views of what does and does
not count as goods to be pursued or harms to be avoided.
Justice
We are required to follow due process in order to determine just
limits on health care that will be generally accepted.