Education And Debate

Medical ethics: four principles plus attention to scope

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6948.184 (Published 16 July 1994) Cite this as: BMJ 1994;309:184
  1. R Gillon
  1. Imperial College of Science, Technology and Medicine, London SW7 1NA.
  • Accepted 16 March 1994

The “four principles plus scope” approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. The approach, developed in the United States, is based on four common, basic prima facie moral commitments - respect for autonomy, beneficence, non-maleficence, and justice - plus concern for their scope of application. It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help doctors and other health care workers to make decisions when reflecting on moral issues that arise at work.

Nine years ago the BMJ allowed me to introduce to its readers1 an approach to medical ethics developed by the Americans Beauchamp and Childress,2 which is based on four prima facie moral principles and attention to these principles' scope of application. Since then I have often been asked for a summary of this approach by doctors and other health care workers who find it helpful for organising their thoughts about medical ethics. This paper, based on the preface of a large multiauthor textbook on medical ethics,3 offers a brief account of this “four principles plus scope” approach.

The four principles plus scope approach claims that whatever our personal philosophy, politics, religion, moral theory, or life stance, we will find no difficulty in committing ourselves to four prima facie moral principles plus a reflective concern about their scope of application. Moreover, these four principles, plus attention to their scope of application, encompass most of the moral issues that arise in health care.

The four prima facie principles are respect for autonomy, beneficence, non-maleficence, and justice. “Prima facie,” a term introduced by the English philosopher W D Ross, means that the principle is binding unless it conflicts with another moral principle …

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