Adapted and taken from our BJA Education paper
In medical school, if you could spell non-maleficence you passed the exam. The four principles are much more than this.
They can help you make objective ethical decisions at the bed space that are individualised to the patient, time and place.
Beauchamp and Childress’s four principles were first published in 1979 in their seminal book, Principles of Biomedical Ethics. The four principles are best understood as a distillation of the ethical theorems that preceded them (Table 1). One common criticism is that the principles are often in conflict with one another and are thus of little practical use. In fact, the inevitable conflict between principles represents the strength of this approach and superiority over alternative ‘mono-ethical’ approaches.
Whilst knowledge of the four principles is important, Beauchamp and Childress spent most of their book explaining how to use the principles rather than just what they are. It is this skill of application that has frequently been deficient in teaching; it is why many clinicians regard the four principles as interesting, but not very useful at the bedside in real, decision-specific, ethical challenges.
Beauchamp and Childress not only gave us the four principles, but the tools to help us classify ethical dilemmas.
Here are the four suggested steps they suggest [1,2]:
(i) Establish the facts of the decision in question.
(ii) Decide what is in scope and out of scope.
(iii) Specify the outcomes within the four principles.
(iv) Balance the principles to give them action-guiding capacity.
Whilst ethicists, and even Beauchamp and Childress, may balk, the common adage ‘classify or die’ should resonate for those of us who have completed medical exams. If complex but critically important concepts are to be remembered, and applied rapidly and reliably at the bedside, then a catchy mnemonic is required.
That's why we created the MORAL Balance ethical framework.
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press; 2001
2. Beauchamp TL. Methods and principles in biomedical ethics. J Med Ethics 2003; 29: 269e74
The Four principles
In medical school, if you could spell non-maleficence you passed the exam. The four principles are much more than this.
They can help you make objective ethical decisions at the bed space that are individualised to the patient, time and place.
Beauchamp and Childress’s four principles were first published in 1979 in their seminal book, Principles of Biomedical Ethics. The four principles are best understood as a distillation of the ethical theorems that preceded them (Table 1). One common criticism is that the principles are often in conflict with one another and are thus of little practical use. In fact, the inevitable conflict between principles represents the strength of this approach and superiority over alternative ‘mono-ethical’ approaches.
Whilst knowledge of the four principles is important, Beauchamp and Childress spent most of their book explaining how to use the principles rather than just what they are. It is this skill of application that has frequently been deficient in teaching; it is why many clinicians regard the four principles as interesting, but not very useful at the bedside in real, decision-specific, ethical challenges.
Beauchamp and Childress not only gave us the four principles, but the tools to help us classify ethical dilemmas.
Here are the four suggested steps they suggest [1,2]:
(i) Establish the facts of the decision in question.
(ii) Decide what is in scope and out of scope.
(iii) Specify the outcomes within the four principles.
(iv) Balance the principles to give them action-guiding capacity.
Whilst ethicists, and even Beauchamp and Childress, may balk, the common adage ‘classify or die’ should resonate for those of us who have completed medical exams. If complex but critically important concepts are to be remembered, and applied rapidly and reliably at the bedside, then a catchy mnemonic is required.
That's why we created the MORAL Balance ethical framework.
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press; 2001
2. Beauchamp TL. Methods and principles in biomedical ethics. J Med Ethics 2003; 29: 269e74