Tom Beauchamp and James Childress, American philosophers, and Raanan Gillon, a British doctor and philosopher, were the pioneers of the following fundamental principles: autonomy, which involves respecting patients’ freedom of choice and wishes; beneficence, which entails acting in the best interests of patients; non-maleficence, which requires avoiding harm (primum non nocere); and justice, which involves treating problems equally and distributing resources fairly to those in need. These four principles serve as the primary guiding principles in current practice, and most other ethical discussions relevant to clinical practice can be categorized under these topics.

Patient information can only be shared in certain situations, such as when required by law, with the patient’s consent, of if it is deemed to be in the public interest. Even after a patient has passed away, confidentiality must still be maintained. In the case of children of young adults, information may be disclosed if it is believed to be in their best interests and they are not capable of making the decision themselves.

The Durham rule states that an individual cannot be held criminally responsible if their unlawful actions were a result of a mental disease of defect. The M’Naghten rule, on the other hand, states that a person is not guilty by reason of insanity if they were unaware of the nature and quality of their actions due to a mental disease, of if they knew their actions were wrong. Additionally, the common law principle of necessity allows for reasonable force and necessary treatment to be used on individuals who lack capacity.

Legal Principles and Acts Related to Mental Capacity and Treatment

A common law principle is a legal concept that is recognized and enforced by courts based on societal customs. The doctrine of necessity allows for the use of reasonable force and necessary treatment for individuals who lack capacity and are in their best interests.

The Mental Capacity Act Deprivation of Liberty Safeguards (DoLS) provides protection for vulnerable individuals who lack capacity and are in hospitals of care homes. It applies to those who are 18 and over, have a mental disorder of disability of the mind, and cannot give informed consent for their care of treatment.

The Mental Capacity Act 2005 governs decision-making for individuals who may lose capacity of have an incapacitating condition. It applies to those aged 16 and over who cannot make some of all decisions for themselves.

Children who understand proposed treatments are considered competent to give consent (Gillick competent). The Mental Health Act 1983 covers the compulsory assessment and treatment of individuals with mental disorders.

The Nuremberg Code is a set of ethical principles for human experimentation that emerged from the Nuremberg trials after World War II. It includes guidelines such as obtaining informed consent, avoiding harm to participants, and not conducting experiments that may result in death.

The Helsinki Declaration, established by the World Medical Association, is another set of ethical principles for human research. It has been amended several times since its adoption in 1964 and provides guidelines for conducting research with human subjects.

The Declaration of Geneva is a statement of a physician’s commitment to the humanitarian goals of medicine. It was created as a revision of the Hippocratic oath and has been amended and revised over time.

The Nightingale Pledge is a statement of ethical principles for the nursing profession. It outlines the responsibilities and commitments of nurses to their patients and the healthcare system.

The four moral principles are a useful tool in clinical practice. For instance, if a patient arrives in critical condition after a car accident and is unable to provide informed consent, the principle of beneficence requires healthcare professionals to prioritize treatment for the patient. The principle of justice may also be considered if there are many patients in need of care of if the treatment is expensive of scarce, potentially depriving others of medical attention. Non-maleficence is relevant if the treatment is likely to cause more harm than good. Respect for autonomy is important if the patient has previously expressed a desire to decline treatment in such circumstances.

The two main ethical approaches in philosophy are teleological ethics, which focuses on the end result, and deontological ethics, which focuses on an individual’s actions being morally right regardless of the end result. In medicine, deontology is patient-centered, while utilitarianism is society-centered. Deontological ethics judges the moral status of actions according to rules of principles, such as the duty not to harm the patient versus the duty to help them. Kantian ethics is a strict form of deontological ethics that emphasizes behaving as though one’s behavior is creating a universal ethical rule. Utilitarianism is a teleological approach that prioritizes the action that leads to the greatest happiness of the greatest number, regardless of how it is brought about. In medicine, autonomy is one of four ethical principles, along with beneficence, non-maleficence, and justice, that enable patients to choose their own treatment and ensure fairness and equality.

Beauchamp and Childress have identified four fundamental moral principles that form the basis of clinical ethics: respect for autonomy, non-maleficence, beneficence, and justice. Respecting a patient’s autonomy involves acknowledging their right to make decisions, even if those decisions may not seem wise. To obtain informed consent, patients must be fully informed about the treatment and its potential outcomes, and they must have the capacity to understand and weigh the information before making a decision. Non-maleficence requires healthcare providers to avoid causing harm, while beneficence involves balancing the potential benefits of a treatment against its risks. Finally, justice requires that healthcare providers act fairly and equitably. When a patient lacks the capacity to make decisions about their care, healthcare providers must act in the patient’s best interests, taking into account their previous views and consulting with relevant parties.

The doctor is adhering to the principle of respecting the patient’s autonomy, allowing them to make their own decisions about their treatment. The four principles of medical ethics, as proposed by Tom Beauchamp and James Childress, include nonmaleficence (avoiding harm), justice (fair distribution of resources), and beneficence (acting in the patient’s best interest).

Healthcare Ethics and Conflicting Principles

British physician Thomas Percival is credited with developing the first modern code of healthcare ethics, which prioritizes the principle of non-maleficence. This principle dictates that a clinician’s primary obligation is to avoid causing harm to the patient, even if it means overriding the patient’s autonomy. This idea has been echoed in classical medical writings and is a fundamental rule in common morality.

In the given scenario, the clinician chooses not to prescribe clozapine, which is likely to cause neutropenia, in order to avoid causing harm to the patient. This decision is in line with the principle of non-maleficence.

However, the principle of autonomy recognizes an individual’s right to self-determination, which can sometimes conflict with the principles of beneficence and non-maleficence. The principle of beneficence requires clinicians to act in the patient’s best interest and prevent harm.

Teleology is an ethical theory that evaluates actions based on their final outcome of causality.