Ethics in Clinical Practice

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Normative ethics addresses the criteria or standards by which we judge whether an action is considered to be right or wrong. Medical ethics is built on a utilitarian ethical structure; it bases what we ought to do on competing principles that are applied in the context of the clinical setting and not on overarching deontological moral imperatives. The guiding principles of American medical ethics are those of respect for autonomy, nonmaleficence, beneficence, and justice (Table 14.1). Autonomy is defined as the right to self-determination, the right to make one’s own choices. The principle of nonmaleficence, often equated with the phrase primum non nocere, first do no harm, is better described as the obligation not to knowingly do harm by either an action or the omission of an action. Beneficence is the act of doing the most possible good; to take the action which will result in the most beneficial outcome for the patient. Justice, in the context of health care, refers to equality of medical treatment and the access to care. For any given clinical situation, the application of each of these principles may give different answers to what is right or wrong [1].