The 4 Principles of Biomedical Ethics

Bioethics encompass the ethical issues that arise in the context of healthcare and biomedical research. This field applies moral concepts and judgment to medical practice and research, helping healthcare providers make decisions that respect patient rights and ensure fair treatment. 

Biomedical ethics is continually evolving, reflecting societal changes and advancements in medical technology.

How many ethical principles of medicine are there? Traditionally, there are four fundamental ethical principles of medicine. These four common morality principles of biomedical ethics, proposed by Tom L. Beauchamp and James F. Childress, provide a framework for ethical decision-making in healthcare. 

1. Autonomy

The principle of respect for autonomy means that individuals have the right to make informed decisions about their own healthcare. Healthcare professionals must respect patients’ self-determinations and permissions, even if they disagree with them.

The patients must have the necessary understanding and mental capacity to make those directives. It involves respecting patients’ values, beliefs, and choices in the process of informed consent and truth-telling. 

An example of autonomy in clinical practice is respecting religious beliefs about blood transfusions. However, there are many other ways how this arm of clinical ethics may play out in day-to-day patient care.

2. Nonmaleficence

Nonmaleficence means “do no harm.” This principle asserts that healthcare providers have a duty to avoid causing harm to patients. In situations where harm cannot be entirely avoided, such as surgery, the potential benefits should significantly outweigh the risks.

An example would be weighing the potential risks and benefits of treating a pregnant woman with cancer.

3. Beneficence

Beneficence means “do good.” The principle of beneficence compels healthcare providers to act in the best interest of the patients. 

This principle can involve actions like providing treatment to improve health and alleviate suffering. It can even go beyond nonmaleficence, such as promoting actions to patients in preventive healthcare, like healthy lifestyle habits.

4. Justice

Justice, in the context of biomedical moral theory, involves fairness and equality in medical care. It implies that all individuals should have equal access to healthcare resources and receive equal treatment regardless of factors like race, gender, socioeconomic status, or health condition.

As the COVID-19 pandemic took hold, major metropolitan regions such as New York became the epicenters of the public health crisis. Doctors, nurses, and other healthcare professionals grappled with complex moral problems tied to the principle of justice, specifically distributive justice when confronted by the harsh reality of limited resources.

Finding Balance When Principles Are in Conflict

As a physician, you will be faced with ethical problems, and the principles guiding your choices may conflict. 

For instance, at times the moral justifications for a patient’s autonomy might conflict with a doctor’s intention for beneficence. In such cases, you must use personal judgment to balance these principles and find a solution that upholds the spirit of the biomedical code of ethics.

Ethical problem-solving requires finding a balance between the principles. There are some critics that argue for more specificity in these principles and improved methods for resolving conflicts. Some even raise questions about universally shared moral norms in our healthcare system because of the multicultural and diverse nature of the world.

Examples of Biomedical Ethics Cases

Biomedical ethics come into play in all different situations in healthcare. For instance, end-of-life care often presents ethical dilemmas. Decisions around administering palliative care, stopping life support, or facilitating assisted dying must be made based on these ethical principles.

The ethical considerations around vaccine distribution, especially during a pandemic, are also rooted in biomedical ethics. The principle of justice comes into sharp focus here, demanding fair and equitable distribution of life-saving resources.

Below are examples of biomedical ethics cases in more depth:

• Surgery Refusal — Principle of Autonomy: A patient might refuse a life-saving surgical procedure based on personal or religious beliefs. Here, the principle of autonomy comes into play. Healthcare professionals should respect the patient’s informed decision even if it contradicts their own views about what would be most beneficial or least harmful to the patient. This case highlights potential conflicts between autonomy and beneficence.
• Euthanasia — Principles of Autonomy and Beneficence: Euthanasia raises questions about patient autonomy and the medical professional’s duty to benefit the patient (beneficence). While the American Medical Association (AMA) generally opposes euthanasia, states like Oregon have passed the Death With Dignity Act allowing terminally ill adults to voluntarily request a prescription for lethal drugs. The ethical considerations of euthanasia include its justification and potential influences on healthy individuals contemplating suicide.
• Surrogacy and Assisted Reproduction — Principles of Autonomy and Justice: Cases involving surrogacy and assisted reproduction bring attention to the emotional attachment of surrogates and the ethics of selecting disease-free embryos. These cases involve the principle of autonomy (informed decision-making by parents and surrogates) and justice (fair distribution of access to assisted reproduction technologies and consideration of potential child’s rights).
• Mandatory Vaccination — Principles of Beneficence and Justice: The ethical dilemmas surrounding mandatory vaccination for diseases like smallpox highlight the balance between individual rights (autonomy) and public health needs (beneficence and justice). Vaccination policies should balance the duty to protect public health (beneficence) and the fair distribution of health benefits and risks (justice) against individual rights to refuse medical treatment (autonomy).
• Suicide Attempts — Principles of Autonomy, Beneficence, Non-maleficence: Managing responses to suicide attempts involves being an ethical decision-maker. Medical professionals must balance respect for the patient’s autonomy with the duty to provide beneficial care and avoid harm. This might involve decisions about involuntary hospitalization or psychiatric treatment, which could be seen as violating autonomy but could be justified under the principles of beneficence and non-maleficence.

Health Care Decision Dilemmas

Biomedical ethical dilemmas arise when there are difficult decisions to be made that involve moral or ethical principles. Given these four examples, ask yourself how the principles of bioethics may apply:

• AI in Healthcare: As artificial intelligence (AI) assumes a greater role in healthcare decision-making, dilemmas arise. Questions of accountability, bias, confidentiality, and decision-making become prominent. For instance, who is responsible when AI makes errors? How can patient privacy be ensured while also using their data to improve AI algorithms?
• In-Vitro Fertilization (IVF) for ‘Healthier’ Offspring: With the increasing use of IVF by fertile individuals for selecting ‘healthier’ offspring, ethical dilemmas such as eugenics and the notion of “designer babies” emerge. Does this practice undermine the value of diversity and inclusivity in society?
• Organ Transplantation and Donation: The shortage of organs for transplantation and the subsequent development of black markets for organs is ethically complex. Issues like equitable access to organs and how to increase the organ donation rate are constant challenges. As a medical professional, how do you decide which patient gets an organ over another patient?
• Gene editing for genetic diseases: The rise of gene editing as a preferred therapeutic approach for genetic diseases brings its own ethical dilemmas. Questions about who gets access to these treatment options, the potential for unintended consequences, and the broader implications of changing the human genome are contentious. Should financial means or the potential harm to the human genome halt care using this method?

Additional Ethical Concepts

Beyond the four principles discussed, there are additional ethical concepts such as paternalism, confidentiality, and scientific validity that are important in healthcare settings. They are all essential components of respecting patient autonomy and maintaining trust in the patient-doctor relationship.

What is the difference between ethical and biomedical ethics? Ethics provide a general guide for moral behavior and decision-making, while biomedical ethics specifically address the unique ethical complexities that arise in healthcare and biomedical research. 

There is overlap between the two, and while biomedical ethics are centered around the four principles discussed, there are other ethical concepts that many physicians will encounter. 

Paternalism

Paternalism, according to medical ethics circumstances, presents a challenge to the principle of autonomy. It involves imposing decisions or restrictions on individuals, often without their consent, for their perceived benefit. 

This approach is based on the presumption that the acting authority has a better understanding of what is best for the individual’s well-being. 

In the realm of clinical medicine, paternalism often emerges from a well-intended desire to safeguard a patient’s health. However, it directly contradicts the principle of autonomy, which values the right of patients to make informed decisions about their own healthcare.

The debate over paternalism versus autonomy is complex and ongoing in the field of medical ethics. Some believe that a balance can and should be struck, taking into account the specifics of each situation.

A great example of this in real-life is an emergency scenario where a patient cannot provide consent. In this case, a healthcare provider intervenes based on their professional judgment of what is in the patient’s best interest, thus leaning towards paternalism.

Confidentiality

Confidentiality in medicine is a key ethical principle crucial for maintaining trust between patients and healthcare providers. This principle requires healthcare providers to keep all information about a patient’s health, including medical conditions, treatments, and personal details, private unless the patient gives explicit permission to disclose it.

Outside of the legal protections from HIPAA, maintaining confidentiality not only falls under respecting autonomy, but it also helps to build trust. A trusting patient is more likely to share all the necessary information a doctor needs for effective treatment. 

Scientific Validity in Research

The ethics of scientific validity in biomedical research are fundamental to ensure that research is ethically acceptable and useful. For any study to be ethical, it must be scientifically valid. Without scientific validity, research poses unnecessary risk to human subjects, wastes resources, and does not contribute valuable knowledge to the scientific community.

Scientific validity in biomedical research is primarily about ensuring that the study design, data collection, and analysis are sound and robust. This ensures the research findings are reliable and reproducible, and thus, can be trusted to inform clinical practice, policy, or further research.

Ethical considerations of scientific validity include:

• Sound study design
• Appropriate methodology
• Accurate data interpretation
• Reproducibility and transparency
• Data integrity
• Risk-benefit ratio

Considerations of scientific validity are integral to the ethical review process that happens before any study can begin.

Preparing For Medical Ethical Principles In Your Interviews

As a part of your medical school interviews, you may be asked to discuss and analyze situations based on biomedical ethical principles. Remember, the key is not merely to recite these principles but to demonstrate your moral character and understanding. 

You want to be able to explain your decision-making process clearly during your interviews, providing balanced perspectives, and showcasing your ability to handle the moral complexities inherent in the field of medicine.

Perhaps give the MedSchoolCoach Casper Preparation program a try. It offers a realistic, simulated exam experience with personalized feedback from experienced physician advisors. The program effectively prepares students for the ethical decision-making.

Applying biomedical ethics is a foundational aspect of being a physician. As medical technology continues to advance and societal values evolve, these principles will continue to guide the course of action and moral compass in healthcare.

Speak with an enrollment specialist about how our Physician Advisors can prepare you for your medical school interviews.