Weighing Medical Ethical Principles

McCormick's Explanation Of The Principles Of Respect For Autonomy, Beneficence, And Non-maleficence Ethically speaking, physicians have a duty to respect the patient's wishes (i.e., they must show respect for patient's desire for autonomy and acknowledge the patient's inherent right to make decisions regarding personal care). But physicians must also respect the principles of 'beneficence' or the idea that the treatments they provide must do the patient good -- and yet not hurt the patient, according to the competing principle of non-maleficence.

McCormick (1998) provides the example of allowing a patient to undergo surgery -- even with a surgery that is an urgent medical necessity, like an infected appendix, there is always some risk about the potential complaints that can be posed by this treatment to the patient (McCormick 1998:7). In this instance, electing to perform the surgery would seem like the obvious decision based on a cost-benefit analysis because of the likely consequences for the patient. But not all decisions are so clear-cut.

What about a teenager who wants breast reduction surgery? The argument of 'autonomy' is more complicated, even if the teen's parents are allowing her to go through with the surgery because she is young and may change her mind in the future and might not be aware of the fact that her body may 'catch up' with her current stage of development. The teen and the teen's parents may not be able to view the future with clear eyes because of an excessive focus on the present.

In terms of doing good (beneficence), the argument in favor of the surgery are the possible physical and psychological benefits. But weight loss might serve the same purposes with less risk and greater benefits. The risk of the surgery, the availability of other options and the potential benefits: all of which must be weighed against one another. Patients' perceptions of their own interests may not be the same as the physicians, as indicated by persons who religiously object to various medical procedures (McCormick 1998:8).

Patients may also prioritize different interests over their physicians. A general practitioner, like the pediatrician of the above-cited teen, might believe that the risks of surgery are too great and that the teen's body type is not extreme enough to justify plastic surgery or that it is best to wait until the teen is fully developed. From the girl's perspective, the fact that she is teased by her peers and is afraid to change during gym class is an argument in favor of the surgery which surmounts any possible objections.

Teens may have difficulty appreciating the future consequences of their actions although the surgery is certainly performed upon consenting adults and is not an 'extreme' procedure. Also, the teen might complain of back pain which could be potentially alleviated by the surgery. A plastic surgeon may have a different perspective of beneficence than a general practitioner as well, believing that the psychological benefits of his practice outweigh any possible harm the surgery might impose.

Another physician might object to the practice of plastic surgery entirely, given the risks of all surgical procedures,.