4 Principles of Medical Ethics

Before we can move on to debating about ethical scenarios whether it be the enforcement of treatment under the Mental Health Act or abortion, we need to discuss the underlying principles behind medical ethics. These may conflict with one another as we will see later.

To make things easier we can say that these principles are like 'pillars' which builds the foundation of medical ethics. 

1. Autonomy

Literally meaning self-rule, it is the capacity to think, decide and act on the basis of the thought and make decisions freely and independently. 

Healthcare professionals can only provide information to ensure patient is fully informed in order to make a decision and respect their final decisions, even if they think that their patient has made the wrong decision. 

*To be able to make a decision, the patient has to have capacity (as assessed by the Mental Capacity Act 2005).

2. Beneficence

The simplified definition of this is to "promote what is best for the patient". However the patient's best interest may not always be what the patient wants. A healthcare professional may determine what is the best course of action for a particular patient, however, the patient would be entitled to their own views, as covered by patient autonomy.

These two principles conflict with one another when a competent patient chooses a course of action which is not in his or her best interest.

3. Non-maleficence

"Do no harm". Again, this may conflict with the other principles as although some treatment may be of benefit to the patient, it may also cause them some harm. 

E.g. Double doctrine effect 

This occurs when the act of doing something morally good may have a morally bad side effect, provided that the side effect is intended.

Doctors give morphine to patients who are terminally ill for the purpose of pain reliever. However, the use of morphine may also hasten death and therefore, causes a degree of harm on the patient. 

4. Justice

This can be divided into 4 components:

a) distributed justice 

• All patients in similar situations should have access to same health care
• Deals with the distribution of limited resources fairly

b) respect for the law

c) rights

d) retributive justice  

• Deals with the fitting of the punishment to the crime

E.g. Person with mental disorder commits a crime

Examples of ethical scenarios:

• Jehovah's Witness refusing blood transfusion 
  (assuming that patient is competent and requires life saving treatment)
• Should a doctor be allowed to give contraceptive pills to a 16 year old girl without parental consent? (Gillick competence)
• Should a doctor break confidentiality and tell the wife of his/her patient that her husband is HIV-positive?

Websites used :

http://www.bbc.co.uk/ethics/euthanasia/overview/doubleeffect.shtml

http://jme.bmj.com/content/29/5/275.full

http://www.ukcen.net/index.php/ethical_issues/ethical_frameworks/the_four_principles_of_biomedical_ethics