Medical Ethics in Healthcare and the Role of its Four Pillars

Ethics in medicine describes the moral principles by which a doctor must conduct themselves. Doctors need to comprehend the concept of medical ethics. It is worth being aware that medical ethics codes are an ever-changing ideal. Something that might been considered ethical thirty years ago may not be given the same importance today. So, what you perceive ethically right today may change tomorrow. 

How to develop medical ethics knowledge?

The best way to develop one’s understanding of medical ethics is to analyze situations using ethical ideologies and frameworks. Medical aspirants can accomplish this task independently, with a fellow medical school applicant or with a teacher who could share their ideas and give their perspectives. Students can try to compare the outcomes shared by others by different frameworks and then consider these implications.

Students must ensure that they stay updated with the latest health news- and see how these ethical frameworks apply to what is currently in the news and the world. 

The importance of medical ethics

Our religions instil in our minds a lot of ethical codes that we accept as moral norms, such as don’t kill, don’t steal, honor your parents, don’t be an adulterer, etc. We accept most of these ethics without placing forth a question but regrettably, they are not encompassing enough for the world of medicine.

Simply abiding by moral codes and carrying a moral character does not provide enough framework for the doctor to understand how to make profound and mindful decisions. Having a medical ethics system that is globally welcomed and followed by doctors hands over to them their power to tackle dilemmas put forward by medicine. It is worth remembering that apart from being the domain for clinical trials, medical ethics forms part of the daily life of every doctor. 

Many great philosophers and physicians, for example, Aristotle, Immanuel Kant, and Hippocrates have tried to define the framework for medical ethics. Most modern Western medicine follows the four principles approach for medical ethics, diligently put forward by James Childress and Top Beauchamp in their book “Principles of biomedical ethics”. 

This system of medical ethics follows four significant principles that eligibly form the four pillars of medical ethics: Autonomy, Non-maleficence, Beneficence, and Justice. 

So here, we will link the importance of medical ethics to the pillars of medical ethics and expand on the ethics.

We will present a medical ethics scenario and hold it up as an example for describing the four pillars of medical ethics and their importance.

The Scenario: A seventy-year-old man is suffering from an abdominal aortic aneurysm (AAA) and is currently at the doctor’s clinic. The doctor has presented the reality of his survival. He has been told that he has a ten per cent chance of bursting and killing him almost instantly every year. He has also been suggested that surgeons can fix the activity, but then he will have a five per cent chance of dying during the surgery. 

Actuality: As you can see, there is no moral conflict. The patient consciously wants to survive, and assuming moral norms, the doctor also wants the patient to be alive. However, this still questions the ethical issues of whether the operation should be done, because the procedure carries an inherent risk that cannot be fully mitigated.

Now, we will explain the scenario in terms of the four pillars of medical ethics.


The ethical norms of autonomy give the right to the patient to choose. Having its meaning rooted in the Greek language, which means self-governance, autonomy is a relatively modern concept. 

A surgeon cannot pressurize him to have the operation regarding the patient with his AAA. Instead, the doctor can point out the facts, including the operational procedures, foreseeable risks, intended benefits, and other data. Now it is entirely on the patient to make a balanced and informed decision, depending on the relevance of the procedure, recovery time, length of hospital stay, etc., to give consent to the operation. 

The surgeons have offered to do the operation and have pointed out the possibility of unintended harm during the process. This leaves it in the patient’s hands to make the final decision. Whether he finds the 5 per cent risk of dying a suitable trade-off for likely extending his life. So, this is a decision that the patient must take autonomously since the five per cent life risk is acceptable to some and not to others.


The non-maleficence code of ethics aims at not inflicting harm to patients. In medicine, liability usually refers to psychological or physical damage. This is a tricky concept for doctors because certainly some procedures have a foreseen side effect, yet they still do the methods.

Coming back to the scenario stated above, the doctors have clearly stated death as an outcome and have mentioned that the patient can feel sick from the anaesthetic effect. He may additionally suffer from the surgery pain. So, how is this foreseen side effect acceptable by the patient?

Non-maleficence is an action that may have two effects, one harmful and one sound. And in the patient’s case, the effect may be weighed up as a moral improvement in lifespan and death. The surgeons may conduct the operation hoping to extend the patient’s life, but with the unintended risk of death during the process. And under these situations, it may be seen morally appropriate to carry out the procedure.


The ethical principles of beneficence is aimed at doing good to patients. Therefore, the actions intended by doctors should contribute to improving the patient’s welfare. 

Beneficence and non-maleficence do not have a sharp cut-off since many medical interventions are both beneficial but carry some risks that may be detrimental. In the patient’s case with AAA, the operation gives him a ninety-five per cent chance of living and is undoubtedly beneficial.

Now, suppose we add an advance procedure in the above case that offers an alternative approach. The advanced approach fixes AAA, but with a one per cent death rate. The only trouble with the advance procedure is that it costs ten times as much. So, now we have constrained beneficence by limiting constraints such as cost. 

In the end, the medical resources are finite, and they should bring results for the population. However, this means that not every treatment may be offered to everybody. And this leads us to the fourth pillar, the pillar of justice.


The ethical principles of justice relate to fairness. 

An example of this could go back to our poor old gentleman with AAA, where he was offered both methods of treatments (less costly and more risk and more costly, less risk). It would be considered injustice if he were offered one procedure if he resided in one part of the country and another option if he lived in another. This would not be looked upon as justice, seeing as he is being discriminated against based on where he lives. 

The term justice also covers an essential point of distributive justice. The widely followed concept in medicine refers to how a person spends their finite money. As seen from the earlier discussion on beneficence, challenging decisions on what treatments are and are not provided in health care are required. 

Parting thoughts,

So, now you are aware of medical ethics, developing them, and their importance. Additionally, we have tried describing the four pillars of medical ethics followed by the modern world. When applying to medical schools, you will be questioned about an ethical dilemma or situation in almost your interviews. If you can show your knowledge of modern medical ethics and how they apply to medical practice, you will be well prepared to get placed in a renowned medical school. 

Author’s Bio: Henry Tesfaye holds a PhD in psychology. He is actively associated with, where he offers psychology assignment help online. You can also resort to him if you have any requirements for nursing assignments and want nursing assignment help. 


Leave a Comment