Ethical Principles

Ethical principles are rules about how people ought to behave. An understanding of these principles is necessary to understand the ethical reasoning process. Upon initial examination, ethical principles may seem simple and straightforward. However, they commonly come into conflict with one another, sometimes creating complicated situations. Some of the most common ethical principles applied to health care include:


Nonmaleficence refers to the duty of health care providers to “do no harm.” This principle was first mentioned in the Hippocratic oath and has since been repeated in one form or another in various professional ethical codes. Few would argue the merit of such a principle. However, the reality of most forms of medical treatment is that there is always the potential for harm. Even something as simple as prescribing an antibiotic to a patient with an infection has some potential to cause harm. Although potential adverse effects of most antibiotics are minor, some could be life-threatening.


The principle of beneficence goes a step beyond nonmaleficence. It states that health care providers must aim to provide benefit for their clients in addition to avoiding doing harm. This principle has served to guide some of the changes that have occurred over the past century regarding the regulation of medications. Years ago, virtually anyone could sell their own version of a remedy, sometimes called “snake oil,” wherever and to whomever they wished. They could make unsubstantiated claims about its curative powers. In most cases, these “remedies” provided no benefit and, worse yet, were sometimes harmful. Since that time, laws have been enacted in the United States that require medications to be proven safe as well as beneficial before they are approved for sale. Such regulation is an example of the principle of beneficence at work.
With beneficence in mind, physicians are obligated to provide medications and treatments that have a reasonable likelihood of helping patients. As a patient faces a decision regarding possible surgery, a diagnostic procedure, or a new medication, the physician must provide information regarding potential risks and benefits. In every case, there is some element of risk, because no procedures or medications are totally risk free. In this decision-making process, the health care provider and patient strive to make a choice that minimizes potential harm (nonmaleficence) while maximizing potential benefit (beneficence).


The principle of autonomy refers to the right of individuals to self-determination. This principle includes the notion of freedom of choice that is so highly valued by all Americans. The right to autonomy allows people to make choices about lifestyle, work, education, and many other issues, such as religion, political affiliation, marriage, and more. Autonomy also includes the right to choose or reject forms of health care treatment. Respecting a patient’s right to autonomy means that the physician and other health care workers must enable the patient to make informed choices. For invasive and otherwise risky treatments, health care providers must, therefore, obtain consent (agreement or permission) from patients.

Distributive Justice

The principle of distributive justice comes from the broader principle of justice, which most Americans hold so dear. The principle of justice is founded on the concept of fairness. The principle of distributive justice then concerns itself with the fair allocation, or distribution, of scarce resources. This principle is especially relevant in the realm of health care, where resources are always scarce. For example, there is a chronic need for transplantable organs, which raises the difficult question of how fair decisions might be made about who receives a transplant and who does not. Furthermore, such difficult decisions must be made to maximize good (beneficence) for the greatest number of people, while minimizing harm (nonmaleficence) to all.


Paternalism may arise in situations where the ethical principles of autonomy and beneficence are in conflict with one another. In this setting, a dominant “paternal” role is taken by a health care provider, judge, or other person or entity who makes a decision for the good of another person, possibly against that person’s wishes. In doing so, the person’s right to autonomy is denied. For example, a parent is allowed to give consent for the medical treatment of her child who is a minor, or an adult is the surrogate decision maker for an elderly parent who has been deemed incapable of making her own decisions because of dementia.


The principle of veracity refers to the quality of truthfulness. This simple principle is generally understood and valued by most individuals, although it is not always an easy one to follow. For example, a physician may need to find a kind but honest way to tell a patient that she has cancer, or the office manager must find a tactful way to talk with an employee about her unacceptable behavior. On the other hand, there may be times when complete honesty is not needed or even appropriate to the situation. Consider the following questions: What should a medical assistant say if a patient asks her for the results of a tissue biopsy? Knowing that such information should only be relayed by the physician, how should the medical assistant respond? What should the medical assistant say when a parent asks about the purpose of her 15-year-old daughter’s appointment with a gynecologist? Should the medical assistant’s response be any different if the parent happens to be a very good personal friend?


The principle of fidelity refers to faithfulness, the duty to keep reasonable promises and meet  obligations. An example of reasonable expectations includes the patient’s right to expect health care providers to respect privacy and maintain confidentiality. A patient also has the right to expect that health care providers will do what they say they will do (keep promises). For example, if a medical assistant states that a phone call will be made or a message conveyed, then the patient is reasonable in expecting that the medical assistant will carry out these tasks. However, at times patients may have unreasonable expectations. For example, a patient who expects a 100% cure rate with every treatment or medication and becomes angry when results do not meet expectations is not reasonable.