FM10.16-17 | Bioethics & the Four Principles — Summary & Reflection

KEY TAKEAWAYS

Bioethics is the systematic study of ethical questions in medicine and the life sciences. The most widely used clinical framework is the four-principle approach of Beauchamp and Childress (Principles of Biomedical Ethics, 1979 onward), comprising: autonomy (the patient's right to informed self-determination); non-maleficence (the obligation to avoid unnecessary harm, primum non nocere); beneficence (the positive duty to act in the patient's best interest, shaped by the patient's own values); and justice (fair and equitable treatment and resource allocation). These four principles are prima facie — they are all binding, but may conflict, and clinical ethics is largely the work of navigating those conflicts. In Indian medical practice, these principles underpin informed consent requirements, confidentiality obligations, resource allocation decisions, and the NMC Code's professional standards. The framework is not a decision algorithm but a structured method for identifying all morally relevant considerations before making a clinical decision.

REFLECT

Return to the opening scenario: the 35-year-old woman refusing intercostal drainage with falling oxygen saturation. Having now studied the four principles, how would you reason through this decision? Consider: Is she competent? Has she been adequately informed? Is there time to assess capacity properly? What does autonomy require? What does beneficence require? Can non-maleficence cut both ways here — acting and not acting both cause harm? What would you document? More broadly: do you believe there are situations where a doctor is morally obligated to override a competent patient's refusal — and if so, what are the criteria? How does your answer align with the law as you currently understand it?