Bioethics Principles
Philippine College of Physicians Workshop
May 2,2026
Introduction
Patient complaint: “Physician prescribed wrong medicine” .
You should
A. Advice her to talk to her physician and find out why
it happened
B. Explain that it is unlikely: doctors check prescriptions
before giving it to the patient
C. Promise to look into the matter and take appropriate
action
D. Suggest she file a formal complaint to the PCP
Committee on Ethics
Introduction
When deciding about complaints you usually
A. Ask someone you respect
B. Look for previous similar cases and
decisions of other committees
C. Rely on your gut feeling
D. Refer to the PCP code
Goals of the Workshop
Empower you to make decisions regarding ethical
problems in an informed critical and effective
manner which balances competing needs, views,
values and beliefs
Present the Principles, Codes of ethics of MMA, PCP,
Mexico principle to serve as guides
Objectives of Presentation
Provide an overview of principles of bioethics
and its application in clinical practice in
order to
expand your perspectives
enhance your competence and
confidence
Outline
Need for ethics
Role of Ethics Committees
Principles as standard
Principles
Meaning, Application, Examples, Take
Home Message
Final Message
Why Ethics?
“Ethical decisions should not be based on a set of
visceral sensations about what you "feel” is good,
instead ethical decision making is a formal, orderly process”
Peregrino.
Ethics is a discipline with a conceptual base and a procedure
Ethics determines what is right or wrong, based on accepted
standards, within context and culture, (not what is
legally/socially/emotionally acceptable).
Internists need accuracy in what they know, honesty in what is
uncertain, and skills in ethical analysis
Role of Ethic Committees
Make informed decisions regarding ethical issues in
an effective manner (and recommend
appropriate action)
Facilitate decision making, resolve issue, counsel
stakeholders (patient, family, physician) when
there’s a difference of opinion
Not be pontifical and shape the decision according
to their values.
Why principles?
Generalizations accepted as true and serve as tools
for analysis and standards for decisions
Easy: state, understand, provide direction and answers
Common: “language” of ethics, basis of most codes,
studies
Relates to patient, self, colleagues, environment
Endured with resilience
Nonmaleficence Beneficence
Do no harm or put at risk of harm Do good (desirable),
Prevent/remove harm
unless to prevent a greater harm except when it causes
or for a greater good greater harm
Obligatory omission Supererogatory commission
despite consent (significant risk, no better
alternative, likely to succeed,
no significant risk for doer,
proportionate)
Proportionality: Good outweighs harm in eyes of stakeholder
Application: Harms Goods
1. physical (hurt, burden)
oppose life/survival preserve/defend
of human species life
destroy well-being restore/promote/remove
threat to well being
Examples
Physical Harm:
All forms of Killing, loss of freedom to have children,
contraceptives, pregnant,
Unnecessary pain,, burden: Violence, pollution, addiction, treachery
futile/redundant procedures/tests/drugs/admission, timing of
visits, withheld/short term treatment, placebo, shortcuts,
Treat patients in dangerous circumstances
Examples
Physical Good
Humane care: attentive, holistic, timely, evidence-based;
Culture of Caring, Safety and Accountability:
listen , respect, respond
true, complete, understood, best alternative advice
ifection control measures , alternatives to use of patients
Care for patients despite dangerous situation
Application: Harms Goods
2. Mental/Psychological
Disturb stability/dignity Empower
shared decision
making
Cause suffering Relieve suffering
Deprive of “rights” Respect “rights”
Examples
2. Mental/psychological harms
“Empathy deficit disorder”: Offend, embarrass, ridicule,
humiliate, disregard feelings
Rude/rough/cruel/abusive manner, look/talk down to
Cause guilt: confront, recall bad experience
Violate privacy and confidentiality, cannibalize
Lose control for decision-making: non-disclose, deceive, coerce
cause fear, harass, intimidate.
Misinform: one picture/minute endorsements, treatment cost ,overestimate
survival
Examples
2. Mental/Psychological good
Sensitive to personal uniqueness: experiences, values, beliefs,
preferences, culture and considerate of feelings (Empathy)
Respectful and honest dialogue
For errors: good faith, good facts, good process, good reasoning;
privacy, honesty, confidentiality transparency, address cause
Culture of Caring: safety, accountability and transparency
Educate content within competence, substantiated, accurate, balanced,
truthful about credentials and COI
Application: Harms Goods
3. Social
Regard as less important Regard as important
Regard as different Regard as “worthy”
or “unworthy”
Ruin reputation Protect reputation,
support
Examples
Social Harm:
Isolate/ Exclude, low priority /opportunity
Speak ill of (bad mouthing) colleague
Misjudge or rush judge
Social Good
Include
Cooperate, collaborate support
Due process if erred
Application: Harms Goods
4. Spiritual
Distance from spiritual solace Encourage spiritual
solace
Remove/fail to provide hope Provide hope
Cause moral blindness, moral Promote “moral calm”
apathy
Examples
Spiritual Harm
Mislead with misinformation,
disinformation,
poor role modeling
Rationalize
Deny spiritual guidance
Spiritual Good
Go near to and explain: accept, attend,
Guide towards the right path
Application: Harm Good
5.Economic
exploitation fair treatment
professional respect,
rivalry fair competition
Examples
Economic Harms
Overpriced vaccines, clinic sold products
Excessive fees
Unnecessary procedures, treatment confinement\s
Solicitation of patients: Unethical advertising,
use of social media/pirating
Economic Good
Reasonable charges and fees
Competition based on service provided
THM Nonmaleficence and Beneficence
1 Do not do anything that leads to the other becoming worse off
because of you
Allow unavoidable, minimal and proportionate harm
2. Do something that leads to the other becoming better off because
of you
Ensure safety and manifest concern
3. Good must outweigh harm in the eyes of the stakeholder
4. Think beyond patient . . . yourself, your colleagues, environment
5. Think beyond physical . . . character, cost, burden
THM Nonmaleficence and Beneficence
6. Give priority of the one on who it is to be done . . .
Listen to the stakeholders!
Platinum rule:“Treat the other as she would like
to be treated”
7. Recognize measurement and quantification difficulty:
Affected by Human Factor (experience and values) and
context
8. Differentiate “intend” from “foresee”
AUTONOMY
Person’s ability to live according to their own reasons and
motives
Free and informed consent
Process of agreeing to/refusing a recommendation
Requirements for valid informed consent/refusal
Capacity to decide
Understood adequate information: what a reasonable
person/this person would need/ want to know
Freedom and voluntariness
Expression
Application: Autonomy
Empower to act autonomously:
Educate regarding rights, decision-making, proportionality,
Provide timely relevant effective truthful information,
Remove barriers, biases, misconceptions
Support choice, reassure
For patient and physician
Protection of vulnerable
vs disproportionate inclusion or exclusion in service, research
Example: Autonomy
Consent prior to any procedure in patient care, research,
learning: no coercion, undue incentives, taking advantage
of ignorance/trust/vulnerability
Consent/refusal of physician to provide patient care: “missions”
Additional/special guidance/measures to ensure no harm a
and free consent (proxy:) Advance directive or Surrogate
decision-maker
Overridden by nonmaleficence: public health measures for
common good: physical distancing, isolation in pandemic
Overridden by justice: : providing a limited necessary resource
to those in greatest need > those who asks for it
THM: Autonomy
IC does not in itself make an action ethical but is a
necessary element of ethical action
Recognize Filipino value of family which affects
consent
Protect the vulnerable
JUSTICE
Give what is deserved
equal benefits/burdens to similar persons
in similar circumstances
Contextual:
what is deserved
fundamental rights: basic healthcare, liberty, due process
who are equal: equality vs equity
priority to disadvantaged
Justice
Justice means Equity: level the playing field
not mere provision of a benefit but addressing
underlying inequality with empathy
JUSTICE
Contextual:
capacity to implement: (limited resources):
process > outcome (listen > give)
accountability and transparency
priority to common good
Examples: UnJust Just
Neglect, ignore, needs respond to needs
ensure standard healthcare
Discriminate; entitle, equal regard and
bias, favorites respect
(Double tier healthcare)
Exploit, exorbitant fees fair fees
under compensation fair compensation
cannibalize truthful acknowledgement
no due process no due process
THM: Justice
Focus on “the other”
how can I “reach”the other
“listen” then “journey together”
Is it fair if
I were to receive?
I were to give?
Final Message
Principles (language of ethics) help physician make ethical decisions
but should not be considered absolute, or mechanically applied:
consider context: listen to stakeholders, reflect, discuss,
return to Natural Law: Avoid evil, Do good”and
professional value: “Service!”
When in doubt,
Ask self: “What would a “good”physician do?
One who is Trustworthy, Humble, and Courageous
Strive and Pray to be one
Principles
consider context
consider context