Four Principles

As its name implies, the approach invites reflection on four ethical principles, which we have slightly adapted here, in order to make links with the work of Clinical Ethics Committees (CECs):

Balancing the principles:

The principles are general guides, which leave considerable room for judgment in individual cases. Beauchamp and Childress recognise that there may be cases where the principles come into conflict. Indeed, we would go further; one commonly defining feature of an ethical issue in healthcare practice can be explained by a conflict between two overarching ethical principles – i.e., a genuine ethical dilemma, where it is simply not possible to do what one ought to do. 

In these scenarios, Beauchamp and Childress recommend following a process of “reflective equilibrium”, which was first outlined by John Rawls in his book A Theory of Justice and is described in detail in Principles of Biomedical Ethics. As an overview, this method involves moving back-and-forth between moral beliefs and judgments, the principles, and background ethical theories, seeking to achieve coherence by bringing these different elements into balance.

We partner with the Institute of Medical Ethics (IME), an organisation which is dedicated to improving education and debate in medical ethics. Visit the IME website