The four principles of healthcare (autonomy, beneficence, non-maleficence and justice) were proposed by Beauchamp and Childress to evaluate ethical issues in medicine from different perspectives. It is important to remember that these are complex ethical principles that balance and oppose each other, and not iron-clad rules that must be taken literally at all times (e.g. non-maleficence and surgery).

Autonomy

The concept that patients should have control over their body and health. While in the past patient autonomy was neglected (i.e. medical paternalism, where doctors gave treatments as they saw fit), informed consent is now considered integral to patient care. On a broader level, libertarians such as John Mills (1859) generally believe it is unethical for professionals or the state to interfere with an individual’s autonomy (liberty) unless they are preventing harm to others. Isaiah Berlin (1958) further distinguishes between negative and positive liberty (autonomy):

• Negative liberty: The ‘negative’ goal of warding off unwanted interference.
• Positive liberty: The ‘positive’ goal of pursuing the freedom to do what the individual themselves want to do

*Autonomy is can be a very different concept when considered within Kantian ethics

Beneficience

The concept that all interventions should have the patient’s best interest in mind. This is especially relevant to clinical research where some individuals may be given inferior treatments to compare outcomes with a potentially better treatment (the dilemma of clinical equipoise). Other considerations, like a clinician should always keep maintain their skills and seek improvement are also relevant. Sometimes, what is ‘best’ for a patient may not be what the patient wants (e.g. blood transfusions for Jehovah’s witnesses).

Non-maleficence

The concept of “do no harm”, often associated with the Hippocratic Oath. Of course, some medical procedures such as surgery require harming the patient for the long-term benefit of their health. Other procedures such as abortion or organ transplants involve harm, for the benefit of another. It is also important to consider negligence or doing nothing may be a form of harm, a concept which can be relevant to euthanasia.

Justice

The concept that healthcare should be fair for all individuals. For example, that treatments should be available to all individuals instead of only those who can afford it. Or that people should not be withheld pain medication just because their particular gender or race means doctors believe they are “faking it”. Important considerations within justice include: rights and obligations, distribution of resources and competing needs. Different philosophers, (e.g. Nozick and Rawls) propose different understandings of what makes something just.