The Four Traditional Pillars of Medical Ethics
Traditional approaches to medical ethics quote the four fundamental principles described below…
- Respect for autonomy of the patient. Autonomy refers to the capacity to think, decide and act on one’s own free initiative. Physicians and family members therefore should help the patient come to their own decision by providing full information; they should also uphold a competent, adult patient’s decision, even if it appears medically wrong.
- Beneficence: promoting what is best for the patient. The general moral principle of doing good to others is focused by the lens of being in a professional caring relationship. The definition of ‘what is best’ may derive from the health professional’s judgment or the patient’s wishes (see Autonomy); these are generally in agreement, but may diverge. Beneficence implies consideration of the patient’s pain; their physical and mental suffering; the risk of disability and death; and their quality of life. At times, beneficence can imply not intervening, if the benefit of therapy would be minimal.
- Non-maleficence: do no harm. In most cases of treating sick patients this adds little to the beneficence principle. But most treatments involve some degree of risk or have side-effects, so this principle reminds us to ponder the possibility of doing harm, especially when you cannot cure. May there be harmful consequences of labelling this patient as having bipolar disorder? In dealing with healthy people (e.g., preventive care, immunizations), do the benefits outweigh the potential harms? Remember that medicine has a long history of doing harm. In the 18th and early 19th century, surgery was highly lethal and giving birth in hospital led to higher maternal mortality than home births.
- Justice. Resources are limited; you cannot cure everybody and so priorities must be set (hence the notion of triage). In allocating care, the Justice principle holds that patients in similar situations should have access to the same care, and that in allocating resources to one group we should assess the impact of this choice on others. In effect, is what the patient is asking for fair? Will it lead to a burden to others (such as the family caregivers)? While your primary duty is to your patient, others will be affected by your decisions and there may be a tension between beneficence, autonomy and justice.