What Are the Key Principles of Biomedical Ethics?

Biomedical ethics is a system of moral principles to guide clinical and administrative practices in the field of medicine. Biomedical ethics plays an important role in determining appropriate treatment for patients, ensuring that medical research is conducted in a just manner and helping clinicians to make complex decisions. American biomedical ethics are based on the four key principles developed by Drs. James Childress and Thomas Beauchamp in their book, "Principles of Biomedical Ethics," which was first published in 1977.

Autonomy

• The principle of autonomy asserts that individuals have a right to determine their own fate, to make decisions and to control what happens in their lives and to their bodies. Autonomy assumes that individuals are responsible for their own well-being and, when given the opportunity, will make choices that are most beneficial to themselves. This principle includes the personal capacity to weigh options and to deliberate in a rational manner. Critics point out that certain patient populations, such as small children, people suffering from extreme mental illnesses or those with cognitive handicaps, may not be capable of making autonomous decisions and that other assurances of care need to be in place.

Nonmaleficence

• Nonmaleficence is the oldest of contemporary biomedical principles and originates in the Hippocratic oath that doctors do no harm. Nonmaleficence refers to the obligation to refrain from and prevent both direct and indirect harms to patients. This principle is complex, as doctors are frequently required to expose patients to harm for the purposes of treatment, such as in the case of chemotherapy or radiation. In these instances, the principle of nonmaleficence guides caregivers to pursue a course of action that carries the least harm, minimizes the risk of death or eases pain.

Beneficence

• While nonmaleficence describes an obligation to prevent harm, the principle of beneficence makes doctors accountable for promoting good and advancing the health and well-being of their patients. Beneficence helps guide medical decisions that not only treat the immediate health problem, but ideally serve to enhance the patient's general quality of life. This principle is based on an understanding of human relationships as reciprocal in nature, and the belief that we help others because we have ourselves received help.

Justice

• The principle of justice refers to the equitable distribution of medical care and resources. This principle has two branches. The first is that of comparative justice, which pertains to competition over a limited medical resource. In comparative justice, the health care one receives is based on an assessment of need or the urgency of a condition. Comparative justice also entails decisions about who or which populations are more deserving of a limited health resource, such as in the case of deciding whether to use a limited supply of medication to treat young children or adults. Distributive justice, on the other hand, involves making decisions about the allocation of medical resources that are not based on the claims of particular people. In distributive justice, health resources are distributed according to economic or social principles rather than individual needs.