The principles, and what to do when they conflict
Five principles, and the fact that real dilemmas are conflicts between them rather than between right and wrong.
Ethical codes across the professions converge on the same five principles. Knowing them is easy; the difficulty is that every genuine dilemma is a conflict between two of them, and no principle is lexically prior to the others.
- Beneficence
- Act for the benefit of those you work with.
- Non-maleficence
- Avoid harm. Where harm is unavoidable, minimise it and be able to justify it.
- Autonomy
- Respect the person’s right to make their own decisions, including decisions you consider unwise.
- Justice
- Fairness in access, in quality and in treatment. Equal treatment of unequally positioned people is not equity.
- Fidelity
- Trustworthiness: honesty, keeping commitments, and not exploiting the relationship.
Where they collide
| Situation | Conflict |
|---|---|
| A competent patient refuses treatment for a life-threatening eating disorder | Autonomy vs. beneficence |
| Breaking confidentiality to prevent harm to a third party | Fidelity vs. non-maleficence |
| Continuing to treat outside your competence because no alternative exists | Beneficence vs. non-maleficence |
| Offering a shorter treatment because the service cannot fund the indicated one | Justice vs. beneficence |
| Reporting suspected abuse against the patient’s wishes | Autonomy and fidelity vs. protection |
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