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⚕️Healthcare Systems

Ethical Principles in Healthcare

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Why This Matters

Healthcare ethics isn't just abstract philosophy—it's the foundation for every clinical decision, patient interaction, and policy debate you'll encounter on your exam. You're being tested on your ability to recognize which principle applies in a given scenario, identify when principles conflict with each other, and articulate how providers should navigate those tensions. These principles show up in case studies, multiple-choice questions about patient rights, and FRQs asking you to analyze real-world healthcare dilemmas.

The ten core ethical principles fall into distinct categories: some protect patient rights and self-determination, others guide provider conduct and obligations, and still others address systemic fairness and resource allocation. Understanding these groupings helps you quickly identify the relevant principle when faced with a complex scenario. Don't just memorize definitions—know what each principle protects, when it might conflict with others, and how it shapes the provider-patient relationship.


Patient Rights and Self-Determination

These principles establish that patients are active participants in their care, not passive recipients. The underlying mechanism is respect for individual agency—recognizing that competent adults have the right to make decisions about their own bodies, even when those decisions conflict with medical recommendations.

Autonomy

  • Patient self-governance—individuals have the right to make healthcare decisions based on their own values, beliefs, and preferences
  • Provider obligation to support choice—healthcare professionals must respect patient decisions even when they disagree with them medically
  • Foundation for other rights—autonomy underlies informed consent, the right to refuse treatment, and advance directive planning
  • Three essential elements—patients must receive information about risks, benefits, and alternatives before agreeing to any treatment
  • Process, not just paperwork—requires clear communication, adequate time for questions, and verification of patient understanding
  • Legal and ethical requirement—obtaining valid informed consent protects both patient autonomy and providers from liability

Respect for Persons

  • Inherent dignity recognition—every individual possesses worth regardless of their health status, background, or ability to pay
  • Active participation model—patients should be treated as partners in care decisions, not subjects of medical intervention
  • Cultural competence connection—requires acknowledging diverse backgrounds, values, and belief systems that shape healthcare preferences

Compare: Autonomy vs. Respect for Persons—both center on patient agency, but autonomy focuses specifically on decision-making capacity while respect for persons encompasses broader recognition of inherent human dignity. If an FRQ presents a patient who lacks decision-making capacity, respect for persons still applies even when autonomy is compromised.


Provider Conduct and Professional Obligations

These principles define what healthcare professionals owe their patients beyond technical competence. The core mechanism is fiduciary duty—providers hold specialized knowledge and power, creating an obligation to use that position for patient benefit rather than personal gain.

Beneficence

  • Active duty to help—healthcare professionals must take positive steps to promote patient well-being and improve health outcomes
  • Beyond avoiding harm—requires actively seeking the best possible care, not just preventing negative outcomes
  • Potential for conflict—beneficence can clash with autonomy when providers believe a patient's choice isn't in their best interest

Non-maleficence

  • "Primum non nocere"—the foundational principle of "first, do no harm" predates modern medicine
  • Risk-benefit analysis—providers must weigh potential harms against expected benefits before recommending any intervention
  • Continuous reassessment—ongoing monitoring ensures treatments remain beneficial as patient conditions change

Fidelity

  • Promise-keeping obligation—providers must honor commitments made to patients, from appointment times to treatment plans
  • Loyalty to patient interests—requires prioritizing patient welfare over institutional pressures, financial incentives, or personal convenience
  • Conflict navigation—ethical practice demands transparency when competing obligations arise

Compare: Beneficence vs. Non-maleficence—beneficence requires doing good while non-maleficence requires avoiding harm. In practice, most interventions involve both: chemotherapy harms healthy cells (non-maleficence concern) to destroy cancer (beneficence goal). Exam questions often test whether you can identify which principle dominates in a specific scenario.


Trust and Communication

These principles govern how information flows in the provider-patient relationship. The underlying mechanism is therapeutic alliance—effective healthcare depends on patients feeling safe enough to share sensitive information and trust the guidance they receive.

Confidentiality

  • Privacy protection—patients have the right to expect their personal health information remains secure and undisclosed
  • Consent-based sharing—information should only be released with patient permission or when legally mandated (reportable diseases, imminent harm)
  • Trust foundation—breaches of confidentiality damage not just individual relationships but public confidence in the healthcare system

Veracity

  • Truth-telling obligation—providers must be honest and transparent about diagnoses, prognoses, and treatment options
  • Informed decision support—truthful communication enables patients to make genuinely autonomous choices
  • Ethical tension point—balancing honesty with compassion when delivering difficult news requires skill and sensitivity

Compare: Confidentiality vs. Veracity—both involve information management but from opposite directions. Confidentiality restricts outward information flow (protecting patient secrets), while veracity requires inward information flow (ensuring patients receive truth). FRQs may present scenarios where these conflict—such as when family members request information the patient hasn't authorized sharing.


Systemic Fairness and Human Dignity

These principles extend beyond individual encounters to address how healthcare systems should function. The core mechanism is distributive ethics—recognizing that healthcare decisions affect not just the patient in front of you but the broader community competing for limited resources.

Justice

  • Fair resource distribution—healthcare resources should be allocated equitably, not based on ability to pay, social status, or personal connections
  • Disparity reduction—requires actively addressing inequities in access and outcomes across racial, socioeconomic, and geographic lines
  • Macro-level implications—individual clinical decisions aggregate into systemic patterns that either reinforce or reduce healthcare inequity

Dignity

  • Respect in all interactions—patients must be treated with courtesy and consideration regardless of their condition, behavior, or circumstances
  • Individuality recognition—care should acknowledge each patient's unique identity, preferences, and life context
  • Experience quality—maintaining dignity throughout care contributes to patient satisfaction, treatment adherence, and health outcomes

Compare: Justice vs. Dignity—justice addresses systemic fairness in resource allocation, while dignity focuses on interpersonal respect in individual encounters. A healthcare system could treat patients with dignity during visits while still maintaining unjust access barriers. Both principles are necessary for truly ethical healthcare.


Quick Reference Table

Concept CategoryKey PrinciplesCore Question
Patient Self-DeterminationAutonomy, Informed Consent, Respect for PersonsWho decides?
Active Provider DutiesBeneficence, FidelityWhat must providers do?
Harm PreventionNon-maleficenceWhat must providers avoid?
Information EthicsConfidentiality, VeracityHow should information flow?
Systemic FairnessJusticeHow should resources be distributed?
Human WorthDignity, Respect for PersonsHow should patients be treated?
Trust MaintenanceFidelity, Confidentiality, VeracityWhat sustains the therapeutic relationship?

Self-Check Questions

  1. A patient refuses a blood transfusion due to religious beliefs, even though it's medically necessary. Which two principles are in direct conflict, and which typically takes precedence for a competent adult?

  2. Compare and contrast beneficence and non-maleficence. How might a single medical intervention involve considerations of both principles simultaneously?

  3. A nurse discovers that a colleague has been accessing patient records without clinical justification. Which ethical principle has been violated, and what broader harm does this cause beyond the individual privacy breach?

  4. An emergency department has one available ICU bed and two critically ill patients who need it. Which ethical principle primarily guides this decision, and what factors should—and should not—influence the choice?

  5. A physician believes a patient would be emotionally devastated by a terminal diagnosis and considers withholding the information. Identify the ethical principles in tension and explain how informed consent relates to this dilemma.