Introduction to the Four Principles of Medical Ethics
The most commonly used framework for current biomedical ethics centers on four core principles. These four principles are:
1. Respect for autonomy – requires respect for the decisions made by autonomous persons.
2. Beneficence – requires that one prevents harm to others, provides benefits, and balances those benefits against risks and costs.
3. Nonmaleficence – requires one not to cause harm to another.
4. Justice – requires the fair distribution of benefits, risks, and costs to a general population.
It is important to recognize that these principles do not function as moral absolutes or laws. This is a frequent misconception. Individual principles should never be conceived “as trumps that allow them alone to determine a right outcome” (Beauchamp & Childress, 2013, p. viii). Rather, principles are prima facie binding. By prima facie,one means that principles or duties must be fulfilled unless they conflict on a particular occasion with an equal or stronger principle, duty, or obligation (Ross, 2009). For instance, one might justifiably break patient confidentiality to prevent someone from harming or killing another person or disclose confidential information about a person to protect the rights of another person. Patient confidentiality must be protected unless a higher principle, such as preventing serious harm to another person, takes justifiable moral precedence. According to Childress (1994), the most defensible principle-based frameworks envision bioethics as principle-guided, not principle-driven.
Because these principles can be derived from different worldviews, traditions, and philosophies, they are necessarily general and broad in their definition and application and provide little direct help with actual moral decision-making and moral rules. Different worldviews interpret these principles in different ways. Disagreements in bioethics usually result from different views about what each principle entails, what they actually mean, and how they ought to be applied.
The way principles are specified and balanced in any given case scenario is also determined by prior moral commitments. Thus, the way in which a Muslim would apply the four principles to a case would differ from the way a secularist would apply them. While the four principles can provide a framework and common language within a pluralistic culture, they still require definition and content, specifying what they mean in given concrete situations and often require balancing two or more of the principles when they come into conflict.
As discussed in this and earlier chapters, a worldview has a significant effect on how one approaches moral dilemmas. Figure 3.2 shows a very simplified hierarchy of moral thinking that begins with one’s worldview that informs one’s ethical theory, which subsequently provides definition and meaning to the principles. From here, one’s understanding of the principles can then be applied to specific ethical cases. It is much more complicated than a simple diagram can convey, but the purpose is merely to illustrate a general concept.
The four principles, especially in the context of bioethics in the United States, has often been critiqued for raising the principle of autonomy to the highest place, such that it trumps all other principles or values. How would you rank the importance of each of the four principles? How do you believe they would be ordered in the context of the Christian biblical narrative? Refer to the topic study materials in your response.