Ethical principles

Four principles

First proposed by Beauchamp and Childress.
Provides a framework for thinking about moral issues - does not give a 'correct' answer.
Usually not all of the principles are directly relevant to a situation.

Autonomy is derived from the Greek for 'self-rule'.
This is about respecting the patient's wishes and involving them in management of their health.
Informed consent is about giving patients autonomy.
Patients are free to decide a course of treatment against medical advice (but see Informed Consent too).

All actions should promote the well-being of the patient.
Doing 'good' for the patient can conflict with the patient's own preferred course of action.
Well-being does not just mean prolonging life, but also the enhancing quality of life, for example by relieving suffering.

Do no harm to the patient.
Is also described by the Latin phrase 'primum non nocere' (first do no harm).
Many interventions involve balancing the risk of harm against the risk of benefit.
The principle of 'double effect' addresses this.
- An action that will cause harm, may be permitted if it also causes greater good - and the harm is unintended.
- This includes the common scenario of giving opioids for pain relief in a dying patient with the unintended effect of possibly hastening death.

This is a utilitarian concept of fair distribution of healthcare resources among the population.
Because of the scarcity of resources in any setting, decisions often need to be made on limits to treatment.
This ranges from NICE guidelines on cost-effectiveness, to making sure enough time is spent with each patient in a clinic.
Autonomy can come into conflict with this if a doctor denies a resource to a patient who wants it.
Beneficence and non-maleficence can also come into conflict if a doctor decides not to provide more of a resource to a particular patient.