We guide patients.What guides us?

A principle is defined as a fundamental proposition that serves as the foundation for a behaviour or for a chain of reasoning (Oxford living dictionary). “Most medical councils or professional bodies is aimed at protecting the interest of profession by promoting the interest of the patients or people it serves” (Singh, 2010). Therefore the basic principles of ethics are there to guide us, as physiotherapy students, to ensure we promote the interests of the patient first.

There are four fundamental principles of “universal ethics”, these include:

  1. Beneficence – do good (Singh, 2010)
  2. Non maleficence – do not harm (Singh, 2010)
  3. Justice –  treat all people equally, fairly, and impartially (Gracyk, 2012)
  4. Autonomy – respect the decisions made by other people concerning their own lives (Gracyk, 2012)

Some resources combine beneficence and non-maleficence. According to Holm (1995) it may be impossible not to harm or to do good to everybody through one’s action, as specific actions affecting one person may be inflicting some type of harm on another, now or in the future. For example by giving a patient crutches from the hospital, I am taking away that assistive device from another patient; even if it not seen immediately, there may be a shortage in crutches in the future while the hospital is still waiting on more to arrive. However, these principles of ethics refer more to intentional harm; this is an important contributing factor leading to our constant research and life-long learning as a physiotherapist, and especially as a student. It is important for us to continuously learn about new conditions we encounter and research evidence-based treatments for each of our patients, not only to do no harm, but to ensure we do good.

“It will be very difficult or realistically impossible to create and maintain a just society” (Holm, 1995). Everyone has a different personality, therefore some people may get along better than with others. This will thereby influence the interaction between the patient and the physician. It may not influence the treatment techniques that are selected for the patient, but may influence the amount of encouragement or enthusiasm expressed by the physician. Each patient may have to be approached differently and have a different effect on us, however it is important to maintain the amount of effort that is put into each patient’s treatment sessions.

“Medical practitioners should analyse their act on basic principles of ethics by themselves and should take their own decision based on conscience” (Singh, 2010). It is our duty not to interfere with the decisions of competent adults, and to empower our patients (Gracyk, 2012). This relates to the power of the relationship between the physician and the patient, and ensuring that the patient understands why certain treatment techniques are being performed. Once the patient has a better understanding, they will be able to make an informed decision about their health.  This can be related to many things in our profession, one in particular that I am trying to improve on is helping my patients understand why exercises are important; ensuring that patients continue doing the appropriate exercises throughout the day and the implications this may have in the future.

It is important to understand the principles of ethics in order to apply it to our daily practice. This is because patients put their trust in us to do our best and help them to the best of our ability. As each situation is different, it is important for us to use our judgement and these principles guide us in doing this.

“even if the four principles approach cannot provide definitive answers it can provide an initial mapping of the moral domain in individual problem cases, it can facilitate the identification of the morally relevant facts, and it can thereby create the basis for an adequate discussion of such cases.” (Holm, 1995)



Gracyk, T. (2012). Four fundamental ethical principles (a very simple introduction). Retrieved from http://web.mnstate.edu/gracyk/courses/phil%20115/Four_Basic_principles.htm

Holm, S. (1995). Not just autonomy – the principles of American biomedical ethics. Journal of medical ethics, 21: 332-338. doi: 10.1136/jme.21.6.332

Oxford university press. (2017) Retrieved from https://en.oxforddictionaries.com/definition/principle

Singh, A. (2010). Ethics for medical educators: An overview and fallacies. Indian journal of psychological medicine, 32 (2), 83-86. Retrieved from http://www.ijpm.info/article.asp?issn=0253-7176;year=2010;volume=32;issue=2;spage=83;epage=86;aulast=


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