Perhaps the best known example of a statement of biomedical ethics is the Hippocratic Oath,
an ancient text that outlines the ethical obligations of new physicians joining the
community of Hippocratic medicine. It is popularly associated with the idea of
“First, do no harm”, although this statement does not actually appear in the text.
Currently, the standard framework by which physicians understand biomedical ethics
are the four principles outlined the the textbook Principles of Biomedical Ethics.
These four principles are:
The health care provider should respect an individual’s autonomy.
An autonomous person is able to act intentionally, with sufficient information,
and without controlling influences. That a person should be free to control
themselves might seem uncontroversial; however, “in a healthcare setting,
where patients are often vulnerable and surrounded by experts, it is easy for a
patient’s autonomous decision to be disrespected”.
This principle is the imperative to “do no harm”.
It is also negligent to impose a “careless or unnecessary risk”
of harm upon the patient. In practice, some subtlety is required.
As many (if not most) medical interventions risk some harm (for example,
think of “side effects”), this principle can more reasonably interpreted
that the benefit should outweigh the harm.
More than doing no harm, the health care provider has a duty to provide
benefit to the patient.
In medical ethics, justice is thought of as fairness.
Healthcare is a scarce, often expensive, resource. The question of how
to distribute healthcare is the central question of medical justice.
Beauchamp and Childress did not provide an answer to how healthcare should
be distributed; not surprisingly, it is a difficult question with different
answers, depending on how you view justice.
Beauchamp and Childress first articulated these principles with the publication of
their book in 1979. In spite of critiques and challenges, these principles have remained
the core of biomedical ethics for almost forty years.
At Evidental, these four principles guide our practice, while delivering dental care, and
when making decisions about the way we run the office.
