Ethical principles (autonomy, beneficence, non-maleficence, justice)

Autonomy - Patient's Right to Choose

• A patient's right to make voluntary, informed decisions about their own medical care, based on their personal values.
• Informed Consent is the core application, requiring:
  • Disclosure: Physician provides diagnosis, prognosis, and details on risks, benefits, and alternatives (R/B/A) for each option, including no treatment.
  • Understanding: Patient must demonstrate comprehension.
  • Capacity: Patient must have decision-making ability.
  • Voluntariness: Decision is free from coercion.
• Exceptions: Autonomy is limited in emergencies, patients lacking capacity, public health threats, or for minors.

⭐ Decision-making capacity is a clinical assessment, not a legal ruling. It requires the patient to communicate a choice, understand information, appreciate the consequences, and reason about their options.

Beneficence - Doctor's Duty to Help

• Core principle: A positive duty to act in the best interests of the patient and promote their well-being.
• Involves actively preventing and removing harm, and weighing the benefits of treatment against the risks and costs.
• Often balanced against autonomy, especially when a patient's decision may not align with the physician's recommended course of action.

⭐ Paternalism is the inappropriate overriding of a competent patient's autonomy in the name of beneficence; it is generally discouraged.

Non-maleficence - First, Do No Harm

• Core tenet: "First, do no harm" (primum non nocere). The fundamental duty to avoid or minimize harm to patients.
• Requires a constant risk-benefit assessment for all interventions. Any potential harm must be outweighed by the potential for good (beneficence).
• Clinical Applications:
  • Avoiding unnecessary tests or treatments with inherent risks.
  • Discontinuing a therapy when its adverse effects outweigh its benefits.
  • Withholding or withdrawing life-sustaining treatment when it is futile or overly burdensome.

⭐ Principle of Double Effect: An action with both a positive effect (e.g., alleviating pain with opioids) and a foreseen but unintended negative effect (e.g., respiratory depression) is ethically permissible if the intended outcome is the positive one.

Justice - Fair Resource Allocation

• Core Principle: Fair, equitable, and appropriate distribution of healthcare resources, balancing individual needs with the needs of society as a whole.
• Levels of Application:
  • Macro-allocation: Societal decisions (e.g., national health budgets, insurance reform).
  • Micro-allocation: Bedside decisions (e.g., who gets the last ICU bed or organ transplant).
• Allocation Criteria: Primarily based on medical need, urgency, and potential for benefit. Avoids judgment on social worth or ability to pay.

⭐ In mass casualty events or pandemics, triage protocols shift to a utilitarian framework: providing the most good for the greatest number of people, which may mean prioritizing patients who are more likely to survive with treatment over those with a lower chance of survival.

High‑Yield Points - ⚡ Biggest Takeaways

• Autonomy is the patient's right to make their own decisions, underpinning informed consent and the right to refuse care.
• Beneficence means acting in the patient's best interest; always aim to "do good."
• Non-maleficence is the core principle to "first, do no harm," avoiding needless risk or pain.
• Justice demands fair allocation of resources and equitable treatment for all patients.
• Ethical conflicts frequently involve clashes between these principles, especially autonomy vs. beneficence.