THE FOUR PRINCIPLES

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In the late 1970s, two Americans, Tom Beauchamp and
James Childress, introduced the idea of the ‘four principles’
or ‘principlism’. Historically, principlism represents
the most widely taught ethical framework in
UK medical schools and probably the most widely used
ethical framework by clinicians in English-speaking
countries.
The four principles are:
• autonomy: the principle of respecting the decisions
made by those capable of making decisions. Autonomy
also includes respecting (as far as is possible)
the autonomy of people whose ability to make decisions
is limited, e.g. by senility or illness
• beneficence: the principle of doing good or providing
benefit
• non-maleficence: the principle that a person should
avoid doing harm, or minimize harm as much as
possible if it is unavoidable
• justice: the principle of ensuring fairness and equity
in the distribution of risks and benefits. This
includes the idea of treating equals equally and recognizing
relevant inequalities.

HINTS AND TIPS
The four principles do not constitute an ‘ethical theory’
as such, rather they are guidelines: a framework around
which an ethical discussion can be based, regardless
of the favourite ethical theory held by the participants.

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