The Four Principles of Biomedical Ethics

The four principles of biomedical ethics as outlined by Beauchamp and Childress have become
the cornerstones of biomedical ethics in healthcare practice. These principles, which we shall
look at more closely in this post, are autonomy, non-maleficence, beneficence and justice.

1. Autonomy

Autonomy itself is essentially the right to self-governance. According to this principle we ought
to have the freedom to live our lives in accordance with what we deem in our best interests in
line with our desires, beliefs and preferences.

Over the last half a decade we have seen autonomy become arguably the most important tenet of
healthcare ethics. In the past we had a paternalistic model in which the practitioner dictated
treatment options and needs to the patient. Now we have moved towards a model based on
autonomy and consent in which the patient has a greater input in decisions which effect their
health.

Autonomy is closely related to the concepts of consent and capacity which will be covered in
more detail elsewhere.

2. Non-maleficence

This is the principle of doing no harm to patients. Beauchamp and Childress state: “the principle
of non- maleficence obligates us to refrain from causing harm to others.”

This is closely related to negligence laws. In healthcare and in general we can identify two types
of situations which may arise in relation to non-maleficence:

1. Intentionally imposing unreasonable risks of harm. An example of this would be a nurse

who knowingly does not change a patient’s bandage despite the increased risk of infection.
2. Unintentionally but carelessly imposing risks of harm. For example a physician who forgets
that a patient does not want certain information disclosed to them which leads to a
breakdown on the patient’s trust in the medical profession.

Beauchamp and Childress identify the following conditions in a professional model of failure of
care:

I. The professional must have a duty of care to the affected party.

II.  The professional must breach a duty.

1. The affected party must experience harm

2. The harm must have been caused by a breach of duty.
 3. Beneficence
Beneficence, or doing good, not only “requires that we treat persons autonomously and refrain
from harming them, but also that we contribute to their welfare.”

Beneficence and non-maleficence can be contrasted to one another:

Non-maleficence:

 Negative prohibitions of action

 Impartial
 Legal and moral prohibitions of certain kinds of conduct.

Beneficence

 Positive requirement of action

 Do not always need to be impartial
 Do not always result in legal punishments if there is a failure to abide by it.

Beneficence can conflict with autonomy and non-maleficence which we shall consider in more
detail later on in this post.

4. Justice:

In the case of healthcare we consider distributive justice which is defined as the “fair, equitable,
and appropriate distribution of benefits and norms.” Often healthcare resources can be limited so
it is the job of public health and healthcare professionals to consider how best to distribute them.
This can be a difficult task and even in the UK we can see inequalities in healthcare based on
geographic locations and socioeconomic factors.

In this final section we will look at the advantages and disadvantages of this model:

Advantages of this model

 It is easy to use
 Intuitive with how we make decisions
 Applies well to most everyday cases which we will encounter

Disadvantages of this model

 For complex decisions it is often considered too simplistic.

  There is no guidance on what to do if two of the principles conflict. For example, when we
consider water fluoridation there is the conflict between autonomy - as the water supply is
being medicated - and beneficence - as it is shown to benefit individual’s oral health.
Beauchamp and Childress do not rank the principles so for these cases we often have to
appeal to other ethical frameworks.

Bioethicists often refer to the four basic principles of health care ethics when evaluating the
merits and difficulties of medical procedures.  Ideally, for a medical practice to be considered
"ethical", it must respect all four of these principles: autonomy, justice, beneficence, and non-
maleficence.  The use of reproductive technology raises questions in each of these areas.

 Autonomy

Requires that the patient have autonomy of thought, intention, and action when making decisions
regarding health care
          procedures.  Therefore, the decision-making process must be free of coercion or coaxing. 
In order for a patient to
          make a fully informed decision, she/he must understand all risks and benefits of the
procedure and the likelihood of
          success.  Because ARTs are highly technical and may involve high emotions, it is difficult
to expect patients to be
          operating under fully-informed consent.

 Justice

The idea that the burdens and benefits of new or experimental treatments must be
distributed equally among all groups in
society. Requires that procedures uphold the spirit of existing laws and are fair to all
players involved.  The health care provider must consider four main areas when
evaluating justice: fair distribution of scarce resources, competing needs, rights and
obligations, and potential conflicts with established legislation.  Reproductive
technologies create ethical dilemmas because treatment is not equally available to all
people.

 Beneficence

Requires that the procedure be provided with the intent of doing good for the patient
involved.  Demands that health care providers develop and maintain skills and
knowledge, continually update training, consider individual circumstances of all patients,
and strive for net benefit.
 Non-maleficence

Requires that a procedure does not harm the patient involved or others in society. 
Infertility specialists operate under the assumption that they are doing no harm or at least
minimizing harm by pursuing the greater good.  However, because
assistive reproductive technologies have limited success rates uncertain overall outcomes,
the emotional state of the patient may be impacted negatively.  In some cases, it is
difficult for doctors to successfully apply the do no harm principle.