Bioethical Principles

Dissecting the "Georgetown Mantra"

Welcome to Bioethics Basics. I’m Aimee – a nurse-turned-ethicist and ethics educator. My goal is to make ethics education more accessible by simplifying complex concepts in bioethics for the busy point-of-care clinician.

This marks my final post for 2025. I appreciate your support and am grateful for the community we are building in this space. I look forward to engaging with you in the New Year - let me know what topics you’d like to see covered next!

Bioethical Principles & Principlism

While there are many approaches to navigating ethical conflict, principlism is a commonly used framework. Widely attributed to Tom Beauchamp and James Childress, principlism articulates four major bioethical principles:

1. Autonomy: Respect for persons; the right to self-determination

   1. Related concepts include the process of informed consent, surrogate decision-making, and advance care planning as mechanisms of respecting and/or extending a person’s autonomous preferences

2. Beneficence: the obligation to do good

   1. Sometimes called a “positive obligation,” meaning we are called to take action to achieve a good on behalf of the patient

3. Nonmaleficence: the obligation to avoid, or minimize, harm

   1. In contrast, this is a “negative obligation” in that we must sometimes not act in order to avoid a harm

4. Justice: fair and equitable treatment; fairness in distribution of goods, risks and benefits

   1. Considerations of justice are at the core of decisions related to resource allocation (think ECMO, organ donation, Crisis Standards of Care algorithms, etc.)

These principles are meant to represent moral norms - guidelines that are thought to have widespread societal support and therefore can be useful in guiding clinical care. For example, most people agree that killing is wrong and would thus be a violation of the principle of non-maleficence. The principles are meant to be non-hierarchical, meaning no one principle automatically overrides any of the others. Of course, societal values change and evolve over time and are not constant across cultures, so therefore the way each of the principles is prioritized in a given situation is context-dependent.

Important Points

• Principles can be useful in articulating the source of an ethical conflict or tension (or simply in communicating about the “thing” you are worried about), however principles alone cannot provide clear guidance about the “right” thing to do. This is where other contextual features and additional ethical analysis can be helpful (including specifying and weighing ethical principles - see below for further reading on this).

• A true ethical dilemma occurs when two principles come into conflict and there is no clear resolution. For example: there is one ECMO circuit available and two patients who need it. We can decide how to most justly allocate the ECMO and provide a “good” to the patient who receives it, however the other patient will inevitably be harmed (conflict between beneficence and non-maleficence).

For Further Reading:

Beauchamp & Childress (2019)

This post is for educational purposes only and does not constitute medical or legal advice.