![]() ![]() However, non-maleficence and beneficence sometimes conflict with autonomy. ![]() In conversations about non-maleficence and beneficence, practitioners often balance the harms and benefits of available options. Or, “Cure sometimes, treat often, comfort always,” which lists the good things practitioners do, especially by being human in the alienating, stressful, and disempowering situations that patients face. You may hear medical practitioners say, “First, do no harm,” which aligns with non-maleficence. Together, they represent two sides of the same coin, as medicine often sets health as its destination but painful, risky treatments as its path. Non-maleficence means avoiding harm, and beneficence means doing good. These documents and conversations enable medical teams and families to respect a patient’s autonomy, even when the patient cannot decide at that moment. To respect patient autonomy in these circumstances, practitioners should encourage advance directives, living wills, and clear conversations with loved ones about quality of life and what should happen if the patient needs resuscitation (e.g., CPR) or life support (e.g., breathing and feeding tubes). However, patients’ capacities to make decisions can be impaired, for example by sedation or falling unconscious. So, even though children do not have capacity to approve complicated, invasive procedures, they can choose their lunch or TV channel. Competent adults are generally assumed to be able to decide what to do with their own healthcare, so long as medical professionals explain the diagnosis and treatment options in ways patients understand.īut autonomy comes in degrees. In clinical settings, physicians typically evaluate patients’ decision-making capacities by checking whether patients can understand the diagnosis and available treatment options, appreciate the risks and benefits of treatments, and offer reasons for their decisions. Respect for autonomy centers on respecting persons’ capacities to make decisions for themselves. “Principles of Biomedical Ethics” by Tom Beauchamp and James Childress 1. Here I explain each principle using examples from contemporary medical practice. ![]() They defend four principles as central to medical ethics: respect for autonomy, non-maleficence, beneficence, and justice. Their book, now in its eighth edition, helped organize the field of medical ethics and remains a standard text. They hoped these core principles would be detailed enough to guide analyses and decisions, yet flexible enough to adapt to different cases and cultures. They developed a set of principles that most ethicists can agree to, an approach named principlism. To try to address this impasse, Tom Beauchamp and James Childress developed a new approach to ethical decision-making in their 1977 book, Principles of Biomedical Ethics. And these disagreements sometimes lead to stalemates in ethical decision-making. And care ethicists argue that we should foremost consider our feelings and the relationships we share.īut there are deep disagreements among advocates of these differing ethical theories. Virtue ethicists argue that actions must help people form better characters or live better lives. Consequentialists argue that you should pick whatever action produces the most good effects for those involved (or avoids the most bad). ![]() For example, Kantians argue that you should treat all people with dignity and act only on rules that everyone can endorse. Some ethicists appeal to an ethical theory, a general explanation of when and why actions are wrong or not. Suppose that you have an ethical problem in medicine or science. ![]()
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