Basic principles of medical ethics applicable to PM&R.

1. Ethics and PM&R
Samuel M. Bierner, MD, MRM

2. Definitions of Ethics
 “The principles of conduct governing
an individual or a profession”-
Webster’s 3rd New International
Dictionary
 “…the term refers not to morality
itself but to the field of study that has
morality as its subject matter.”-
Encyclopaedia Britannica, 1993

3. Applied Ethics
 “Practical, or applied, ethics is the
application of normative theories to
practical moral problems.”
 “The value of such work began to be
widely recognized only during the
1960s, …first the US civil rights movement
and then the Vietnam War”
– Encyclopaedia Britannica 1993

5. Emily Dickinson
 Pain has an element of blank;
 It cannot recollect
 When it began, or if there were
 A day when it was not.
 It has no future but itself,
 Its infinite realms contain
 Its past, enlightened to perceive
 New periods of pain.~

6. Oath of Hippocrates (excerpt)
 Into whatever houses I may enter, I will come for the benefit of
the sick, remaining clear of all voluntary injustice and of other
mischief and of sexual deeds upon bodies of females and
males, be they free or slave.
 Things I may see or hear in the course of the treatment or even
outside of treatment regarding the life of human beings, things
which one should never divulge outside, I will keep to myself
holding such things unutterable [or “shameful to be spoken”].
 If I fulfil this oath and do not violate it, may it be granted to me to
enjoy life and art, being honored with fame among all men for all
time to come; if I transgress it and swear falsely, may the
opposite of all this be my lot.~


7. Beneficence
 Beneficence refers to an action done to
benefit others.
 Principle of beneficence = a moral
obligation to act for the benefit of others.
 Benevolence is the character trait of being
disposed to act for benefit of others.
• -Principles of Biomedical Ethics, 2001 Oxford

8. X has obligation of beneficence to Y
if and only if:
 Y is at risk of significant loss of or damage to life
or health;
 X’s action is needed to prevent this loss or
damage;
 X’s action has a high probability of preventing it;
 X’s action would not present significant risks or
burdens to X.
 The benefit for Y outweighs any harms, costs or
burdens that X might likely incur.
• Principles of Biomedical Ethics, 2001 Oxford

9. Nonmaleficence
 “Primum non nocere.”
 Above all, do no harm.
 Hippocrates: “I will use treatment to
help the sick according to my ability
and judgment, but I will never use it
to injure or wrong them.”

10. Negligence
 Negligence is the absence of due
care. Two types:
1. Intentionally imposing risks of harm
that are unreasonable
(recklessness)
2. Unintentionally, but
carelessly, imposing risks of harm.
Principles of Biomedical Ethics, 2001