BMS 115 · Common Core (Tronc commun)Section 1.1 · Foundations of health care ethics

Section 1 of 15

What health care ethics is and why it matters

Define health care ethics, explain why a profession that works on human life cannot practise without it, and state the purposes it serves.

New to this course? How each section works

Learn gives you one short idea at a time. Each idea starts with a single sentence, then explains it, gives an example, and asks you a small question you can answer straight away.
Explore shows a diagram of the same ideas. Click the numbered parts to read what each one is.
Check asks a few questions. Answer them all correctly to finish the section and unlock the next one.
“Go deeper” is optional. It adds mechanism and extra detail for when you are ready — nothing you need for the checks is hidden there.

Why this matters

You are about to care for people at the worst moments of their lives, and you will do it with your hands, in a hurry. The lecture notes open with the reason this course exists: the professions of health have the peculiarity of working on a human being, so no error — conscious or unconscious — is allowed, because the slightest negligence can be fatal for the patient. Ethics is not a decoration added to technique. It is the discipline that decides what technique is for, who is entitled to it, and how far you may go with it.

What you need to know first

You do not need any philosophy to begin. You need three ordinary abilities you already use: noticing that two people want different things, saying honestly why you did something, and asking yourself whether you would accept the same treatment in the patient’s place.

Words to know (5)

Ethics: The branch of thought that studies the principles, norms and values that ought to guide behaviour, and reflects on whether they are valid. Asking whether a nurse may ever lie to a patient is a question of ethics.
Health care ethics (medical ethics): The collection of principles and codes of conduct that guide doctors, nurses and other clinicians in providing medical care, combining moral belief with the provider’s duty toward others. The rule that a nurse obtains consent before giving care is part of health care ethics.
Deontology: The part of ethics that studies duty: what a professional must do or must refuse to do because of the rules of the profession. A code of ethics that forbids practising under the influence of alcohol is a deontological text.
Negligence: A failure to give the care, attention or skill that the situation required — whether by acting carelessly or by failing to act, and not necessarily a deliberate act of harm. Forgetting to check a patient’s identity before a procedure, with harm as a result, is negligence; so is a hurried injection given at the wrong dose or by the wrong route.
Humanisation of care: Treating the patient as a whole person with dignity rather than as a case, a bed number or a task to be completed. Explaining a procedure to a frightened patient before starting, rather than silently beginning, humanises the care.

One idea at a timeIdea 1 / 3

In one sentence Health care ethics is the set of principles and codes of conduct that guide clinical decisions about what is right and wrong.

Health care ethics is the discipline that decides what health care is for

Health care ethics provides guidelines and codes of conduct that enable us to make better decisions in health care; that is, it guides us to make good decisions. It concerns right and wrong. It can also be defined as the collection of principles that guide doctors, nurses and other clinicians in providing medical care, combining moral beliefs — a sense of right and wrong — with a sense of the provider’s duty toward others. Health care ethics covers how providers treat patients. Advancements in medical knowledge and in medical technologies bring with them new and important moral issues, and ethics in health care is what guides the work of professionals in the industry.

For example

A new machine can keep a patient’s heart and lungs working after the brain has stopped. The machine works perfectly. Whether to switch it on, and when to switch it off, is a question that no machine can answer for the team.

Think of it like

Think of technique as a car and ethics as the steering and the road. A more powerful car does not tell you where to go; it only makes the consequences of a wrong direction larger. The comparison stops here: unlike a road, moral direction is not painted on the ground for you to follow.

Pause and check yourself

A hospital buys a more accurate scanner. Does that purchase alone make the department more ethical?

Show the answer

No. Better equipment enlarges what the department can do; ethics decides who should be scanned first, who cannot pay, what the patient is told, and whether the scan is needed at all. A technical improvement is not a moral improvement.

Read detailed explanations

Where the discipline comes from: ethos, mores and the two ways of reading a moral problem: The English word ethics descends from the Greek ethos, which designates the settled dwelling place of a community — its accustomed ways. Morality descends from the Latin mores, meaning convention or practice. The two words are therefore etymological cousins, and some authors use them as synonyms, one Greek and one Latin. Other authors separate them, and the separation is worth learning because it decides what kind of question you are asking. In the separated sense, morality is the lived standard — the set of standards that enable people to live cooperatively in groups, the things a particular society determines to be right and acceptable. Ethics is the reflective, theoretical inquiry into those standards: the study of the principles, norms and values that must be respected, and a reflection on their validity, on conformity to the good, to virtue or to the love of God. The goal of ethics is to reach universal moral standards on the basis of a reflective analysis of the human being. The practical consequence is this: a nurse can be moral, in the sense of following what the ward expects, and still fail an ethics question, because the ward may be wrong. Asking “what do people here do?” is a morality question. Asking “is what people here do defensible?” is an ethics question, and only the second one can move a practice forward.
Rule ethics and consequence ethics: why deontology alone runs out: Deontology is an ethical theory that says actions are good or bad according to a clear set of rules. Its name comes from the Greek deon, meaning duty; actions that align with the rules are ethical and those that do not are not. Deontology is often associated with Immanuel Kant, who held that ethical actions follow universal moral laws such as “do not lie, do not steal, do not cheat”. Its great strength is that it is simple to apply, and it fits our natural intuition about what is or is not ethical. Its weakness is exactly the same simplicity, because it tells us to disregard the consequences of our actions when determining right and wrong. The lecture notes give the classic illustration: you are a software engineer and learn that a nuclear missile is about to launch and may start a war; you could hack the network and cancel the launch, but breaking into a software system without permission is against your professional code of ethics and is also a form of lying and cheating. Deontology advises not to violate the rule. In letting the missile launch, thousands of people die. That is the price of a rule-only ethics, and it is why professional practice needs a second tool. Consequentialist reasoning asks which available action produces the best overall result, and it is what a clinician uses when weighing a painful treatment against its chance of cure. Neither tool is sufficient alone. A professional who uses only rules refuses to think about outcomes; a professional who uses only outcomes discovers that every rule can be broken for a good enough reason. Health care ethics in practice is the disciplined combination: rules that set the floor, consequences that inform the choice above the floor, and a written reason for whichever path is taken.
Bioethics: the questions that appear when medicine becomes powerful: Bioethics is a specialised area of ethics dealing with issues of birth, death, health care, new medical technologies, reproductive technologies, drug use, organ transplants, the costs of health and the rights to health. Its role is to provide criteria for discerning in these areas. The criteria it supplies are not arbitrary; the notes name the ones that recur: quality of life, the autonomy of the person, the right of the patient to decide for himself, the right and the duty to heal and to be cared for, the use of adequate means to maintain one’s health and life, the inviolability of the body, and confidentiality. Notice how several of these criteria pull in opposite directions, which is what makes bioethics a discipline of judgement rather than a lookup table. Consider organ transplantation, where the notes’ list of criteria becomes a real allocation problem. The technical ability to transplant creates a scarcity: more people can benefit than there are organs. Quality of life asks which recipient gains the most years of functioning life; autonomy asks whether the donor or the family truly consented and whether the recipient may refuse; the inviolability of the body constrains how organs may be obtained at all; justice asks whether the queue is ordered by need, by waiting time, by ability to pay or by social worth, and demands that the rule be published in advance. A second recurring area is reproductive technology, where the same criteria reappear around the status of the embryo and the meaning of parenthood. The value of learning bioethics as a list of criteria is that it gives a beginner something to say in a meeting that is not merely “I feel”. It converts a disagreement into an argument that can be examined, tested against the facts of the case and recorded for the next team.

Explore the diagram

Look at the whole drawing first. Then select one numbered part and connect it to the idea you just read.

A nurse and patient discuss care at eye level in a private room. The patient asks a question. — Teaching schematic, not a clinical algorithm. The four principles are shown as questions the team asks, not as four votes of equal weight; in a real case they interact and one may constrain another.

Key points to remember

Health care ethics is the set of principles and codes of conduct that guide clinical decisions about right and wrong; it combines moral belief with the provider’s duty to others.
The health professions are peculiar because the material is a living human being of absolute dignity, so thoughtful care replaces haste at every step.
Ethics serves six practical purposes: identify moral issues, know what should or should not be done, respect personal and civic rights, treat patients with dignity, make decisions fair and just, and humanise care.
Ethics is a public and teachable discipline, not a private taste; ordinary care, not only dramatic cases, is where ethical habits are built.

Go deeper

Worked example

A night shift with one free bed. At 02:00 the emergency department has one monitored bed left. Two patients arrive within ten minutes. Patient A is 34 years old with severe breathlessness from a treatable asthma attack. Patient B is 79 years old, drowsy, with advanced cancer and a chest infection; the family say she has said repeatedly that she does not want to be kept alive on machines.

Name the ethical question before naming the diagnosis. The question is not “who is sicker?” but “who can benefit from this specific bed, and what did each patient say they wanted?” Naming the question is the first of the six purposes and it changes what the team collects next.
Separate the facts from the assumptions. Facts: one bed, two patients, one clear statement of preference from patient B. Assumptions: that age alone should decide, that the family’s report is second-hand hearsay, that the asthmatic patient is certainly salvageable. Each assumption needs checking before it is used.
Apply the four principles you will meet in section 1.3 as questions, not as votes. Beneficence asks which patient the bed will actually help; non-maleficence asks whether ventilation would prolong suffering for B; autonomy asks what B wanted while she could say it; justice asks how a rule written for these two patients would treat the next two.
Decide who decides. The nurse does not allocate the bed alone. The decision belongs to the team with the senior clinician accountable for it, and it must be recorded with the reasons, because ethics that is never written down cannot be reviewed or defended.
Continue to care for the patient who does not get the bed. The ethical duty does not end with the allocation. Patient B still needs symptom relief, honest explanation, and a plan that respects her stated wish; being second in a queue is not abandonment.

The bed goes to the patient the intervention can still help, and B receives comfort care, an honest explanation and her stated wish recorded in the notes. The team also records why, so that the next night shift inherits a reason and not merely a decision. Notice that no step required advanced philosophy: each one required naming, checking and writing down.

Common misconception

The commonest beginner mistake is to believe that ethics is a private opinion, so that “my ethics” and “your ethics” are simply two tastes and the loudest voice wins. That is wrong in a profession. Ethics is a public, teachable discipline with shared principles, published codes and reasoned arguments that can be examined by others. You may disagree with a colleague, but you must argue from a principle, from the patient’s rights, and from the facts — not from preference. The second mistake follows from the first: beginners often think that ethics is for difficult cases only, and that ordinary care is ethically neutral. In fact almost every act of care — consent, hygiene, honesty, confidentiality, how you speak to a frightened person — is already an ethical act, and it is in ordinary care that the habits are built.

Check your reasoning

Think of one moment in your own life when a professional — a nurse, a teacher, a clerk — did something technically correct that nevertheless felt wrong to you. Was the problem the technique, the outcome, or the way you were treated? Which of the six purposes of ethics would have helped them see it?

Reveal an answer

Most people find that the technique was correct. What was missing was being told, being asked, being believed or being treated as a person. That is precisely the territory of health care ethics, and it is why the notes end with the humanisation of care: the discipline is not only about avoiding disasters, but about the quality of the relationship in which care is given. Naming which purpose was missing — respect for rights, fairness, humanisation, or simply identifying the moral issue — turns a vague memory of being wronged into a usable professional lesson.

Where this comes from

BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter 1 — Introduction to health care ethics: definition, importance of ethics and deontology, purposes of ethics in the health professions
Beauchamp & Childress, Principles of Biomedical Ethics · Extended for the four-principles vocabulary introduced in section 1.1 and used in sections 1.3 and 5.1; the notes state the principle names and clinical examples
Stuart Mill, Utilitarianism · Background for the consequentialist contrast with deontology in the detailed explanation
UNESCO Chair in Bioethics · case-study collection · Further reading named in the course reference list

Lesson progress is saved on this device for the current learner. Practice answers stay separate and are not stored.

About this course and its sources

Bilingual lessons organised from the supplied BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey, St Louis University Institute Douala) and the international texts those notes reproduce — the Universal Declaration of Human Rights 1948, Pacem in terris 1963, the African Charter on Human and Peoples’ Rights (drafting launched at Monrovia in 1979 by Decision 155; adopted 1981; in force 21 October 1986), the 1959 Declaration of the Rights of the Child, the ICN codes of 1953 and 1973, and the Cameroon code of ethics of 3 March 1989. The short guided notes and the longer “Read detailed explanations” panels are written as two different jobs: the notes state one idea plainly, and the detailed panels add mechanism, vocabulary and worked judgement that the notes do not contain. Diagrams are original teaching schematics. Ethics, nursing and French-language review are pending.