which our basic approach to ethical thinking shapes the day-to-day practical
decisions we might make.
2.4 Principles of health care ethics
One approach to health care ethics which has gained widespread currency is to set
out fundamental principles ,each of which needs to be taken into account when we
make ethical judgements. This approach ,and the so-called `four principles' have
been made famous by the work of Beauchamp and Childress [6] and Raanon
Gillon [7 ,8]. The four principles are:
- the principle of respect for autonomy;
- the principle of nonmaleficence;
- the principle of beneficence;
- the principle of justice.
In short ,this means that in deciding how to act ,health professionals ought to
respect autonomy ,avoid harming ,where possible benefit ,and consider 6fairly) the
interests of all those affected. This is not a formula for ethical decision making,
rather it is a broad framework which can be used as a basis for organising ethical
deliberation and discussion.
There is no substitute for reading about this approach in the source texts
referred to above. These make quite clear the difficulties in interpreting and
applying these principles ,and the ways in which they tend to conflict with one
another in practice. We have already seen that the idea of autonomy ,and the ideas
of costs and benefits ,are open to different interpretations ,and the idea of justice is ,
if anything ,even more controversial. For example ,some people would argue that a
health care system in which health care is distributed by an open market ,in which
everyone has an opportunity to buy care ,is perfectly just. Whereas others would
see this as profoundly unjust ,arguing perhaps that health care ought to be dis-
tributed according to need.
This four principles' approach has come under criticism for being too super- ficial or too limited. Some of this criticism can be dismissed because it is based on false assumptions about the proponents of this approach. They are not arguing that all ethical thinking can be reduced to a few key words ,or that the four principles provide a quick and easy method for solving ethical dilemmas. They are arguing that the principles provide a reminder of the key dimensions of ethical thinking ,and that they can provide a common vocabulary and framework for individuals with different outlooks or philosophies. Although its proponents have produced sophisticated replies to critics ,this approach is ,in part ,designed to avoid the paralysis of endless theoretical debate ,and to be of practical help in real cases. Leaving aside the question of its ultimate validity ,the practice of applying the principles to cases provides important lessons for nursing ethics. Although the principles supplyrules of thumb' we cannot assess what we ought to do in a
specific case without considering the particular circumstances of the case. Ethical
judgement depends crucially on questions of fact as well as questions of principle,
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