Principles of medical ethics

The four principles, drawn twice

The genetics file draws Medical Ethics as four rings of a chain, one principle to a ring, each with its own line:

• Autonomy: Respect for Autonomy
• Non-maleficence: Do no harm
• Beneficence: doing good
• Justice: Treat patients equally

A lock hangs on the chain between Non-maleficence and Beneficence, and the lock reads confidentiality, with one line under it: Patient versus family. The title of the slide is Ethics in Medical Genetics.

The ethics file gives the same four as a method, under the words Solution Using the 4 Ethical Principles, from How to Resolve Ethical Issues in Practice:

• Patient autonomy = patient decides
• Beneficence = bring benefit
• Nonmalefacence = cause no harm
• Justice = treat all with equity

The two files do not agree on how to write the second one: Non-maleficence in the genetics file, Nonmalefacence in the ethics file. The meaning is the same in both, cause no harm.

The dilemma is not which principle but whose

The genetics file draws the ethical dilemma as a balance with two pans. On one pan, Autonomy/ whom? On the other, Non-maleficence and beneficence, whom? Under the base, the words Ethical dilemma. The balance is drawn level, neither pan down.

So the question is not which principle wins. It is whose autonomy is at stake, and whose harm and whose good. That is why the lock in the other slide reads confidentiality with patient versus family under it: both are already in the room.