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Student Education

Biomedical ethics: The basic principles

BMJ 2003; 326 doi: https://doi.org/10.1136/sbmj.0305142 (Published 01 May 2003) Cite this as: BMJ 2003;326:0305142
  1. Pierre Mallia, family doctor and lecturer in family medicine and biomedical ethics1
  1. 1Faculty of Medicine and Surgery, University of Malta

In the first part of our new series, Pierre Mallia explains the basic principles of ethics

Doctors are often confronted with ethical dilemmas. From not respecting patients' autonomy by not complying with a request for an antibiotic to deciding who should get a scarce resource such as a kidney, ethical dilemmas are found everywhere from primary care surgeries to hospital settings. In bioethics, moral problems raised by new medical technologies are debated. In this series I will consider topics including organ transplantation, genetic engineering, assisted suicide, assisted procreation, and patient rights. To discuss these issues we first need a set of principles--ground rules--which can guide our discussion and on which there is general agreement.

Old and new

Medical ethics are often construed as “old” and “new.”1 Old medical ethics were basically a list of do's and don'ts for the doctor and were based on professional authorities, which determined their own ethics. The primary ethical principle was the benefit of the patient. As long as the doctor was serving the patient, he or she was allowed to deceive, coerce, and, in general, be paternalistic.

In contrast, new ethics is thought of differently--as a philosophical study of underlying principles. More people, including non-doctors, work to devise ethical standards. The patient's benefit or beneficence is only one among other competing principles.

Four principles

Today, four basic principles that guide moral deliberation in bioethics are largely accepted (see box).2 These principles largely originate from the doctor-patient relationship. Use of the principles is dependent, however, on the virtues of the moral agent (the person making the moral choice--that is, the doctor) and not the simple prescription of an algorithm.

The basic four

  • The principle of beneficence

  • The principle of non-maleficence

  • The principle of justice

  • Respect for patients' autonomy

Patients visit medical professionals because of the patient's expectation that the professional can …

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