[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Medical ethics](https://durgical.com/en/medical-ethics/) › Foundations of bioethics # Foundations of bioethics The four principles, ethical theories, paternalism, double effect and how to work through a case. 37 pages ## Principle - [**Beneficence** Beneficence is the duty to act for the patient's good: prevent, cure, relieve and help](https://durgical.com/en/medical-ethics/beneficence/) - [**Justice: fair distribution and equal treatment** Justice asks us to treat like cases alike and to share health resources by fair, public criteria](https://durgical.com/en/medical-ethics/justice-fair-distribution-and-equal-treatment/) - [**Nonmaleficence: «first, do no harm»** A doctor must not cause the patient avoidable harm or expose them to risks that no benefit…](https://durgical.com/en/medical-ethics/nonmaleficence-first-do-no-harm/) - [**Respect for autonomy** A capable, informed person has the right to decide about their own body and treatment, even when…](https://durgical.com/en/medical-ethics/respect-for-autonomy/) - [**The principle of double effect** An act with one good and one bad effect may be permissible if only the good is intended and the…](https://durgical.com/en/medical-ethics/the-principle-of-double-effect/) ## Theory - [**Ethical theories in brief: duty, consequences, virtue, casuistry, care** Ethical theories give different reasons for what is right: duty, consequences, character or…](https://durgical.com/en/medical-ethics/ethical-theories-in-brief-duty-consequences-virtue-casuistry-care/) - [**Foundations of bioethics: is, ought and values** Facts alone do not tell us what we ought to do: a clinical decision joins data, values and…](https://durgical.com/en/medical-ethics/foundations-of-bioethics-is-ought-and-values/) - [**Justifying a moral judgement: top-down, casuistry, reflective equilibrium** A moral judgement is justified by applying a theory, comparing with clear cases, or adjusting…](https://durgical.com/en/medical-ethics/justifying-a-moral-judgement-top-down-casuistry-reflective-equilibrium/) - [**Kantian ethics: duty and persons as ends** For Kant, an act has moral worth if done from duty, and every person is always treated as an end…](https://durgical.com/en/medical-ethics/kantian-ethics-duty-and-persons-as-ends/) - [**Ranking the principles: Gracia's two levels (ethics of minimums and maximums)** Gracia ranks the four principles on two levels: not harming and fairness bind everyone; autonomy…](https://durgical.com/en/medical-ethics/ranking-the-principles-gracia-s-two-levels/) - [**Rights theory: rights, duties and their limits** A right is a justified claim that binds others; every right has a matching duty held by someone](https://durgical.com/en/medical-ethics/rights-theory-rights-duties-and-their-limits/) - [**The ethics of care** The ethics of care puts relationships, dependency and concrete attention to each person's needs…](https://durgical.com/en/medical-ethics/the-ethics-of-care/) - [**Utilitarianism in medicine** Utilitarianism judges acts by their consequences: what produces the greatest total well-being is…](https://durgical.com/en/medical-ethics/utilitarianism-in-medicine/) - [**Virtue ethics** Virtue ethics asks what kind of person the doctor should be; acting well is acting as a virtuous…](https://durgical.com/en/medical-ethics/virtue-ethics/) ## Topic - [**Ethics and law: why legal is not always ethical** The law sets the minimum that can be enforced with sanctions; ethics usually asks for more, and…](https://durgical.com/en/medical-ethics/ethics-and-law-why-legal-is-not-always-ethical/) - [**Expanded access and compassionate use** It means giving a not-yet-approved product, outside a trial, to a seriously ill patient with no…](https://durgical.com/en/medical-ethics/expanded-access-and-compassionate-use/) - [**How bioethics was born** Bioethics arose in the United States between 1960 and 1980, when new medical technology and…](https://durgical.com/en/medical-ethics/how-bioethics-was-born/) - [**How informed consent arose: the key court cases** Informed consent was born in US courts: first the right to decide about one's own body, then the…](https://durgical.com/en/medical-ethics/how-informed-consent-arose-the-key-court-cases/) - [**Moral dilemmas and prima facie duties: specifying and balancing** A prima facie duty binds unless it clashes with a stronger one; in a dilemma the norms must be…](https://durgical.com/en/medical-ethics/moral-dilemmas-and-prima-facie-duties-specifying-and-balancing/) - [**Moral distress, moral regret and residual obligation** Moral distress is the strain of knowing what is right and being unable to do it because of…](https://durgical.com/en/medical-ethics/moral-distress-moral-regret-and-residual-obligation/) - [**Moral pluralism, disagreement and civil ethics** In a society with many moral outlooks, civil ethics looks for the shared minimums everyone can…](https://durgical.com/en/medical-ethics/moral-pluralism-disagreement-and-civil-ethics/) - [**Moral status: who counts, the five theories and degrees** Having moral status means a being's interests count in their own right; theories disagree on…](https://durgical.com/en/medical-ethics/moral-status-who-counts-the-five-theories-and-degrees/) - [**Obligation, supererogation and moral ideals (the duty to treat in epidemics)** Some acts are required; others, heroic or generous, go beyond duty](https://durgical.com/en/medical-ethics/obligation-supererogation-and-moral-ideals/) - [**Obligatory and ideal beneficence: the duty of rescue** There is a duty to help when someone faces serious danger, you can prevent it and the cost to…](https://durgical.com/en/medical-ethics/obligatory-and-ideal-beneficence-the-duty-of-rescue/) - [**Paternalism: soft, hard and why it declined** Paternalism is deciding for another person, against their will, with the intention of doing them…](https://durgical.com/en/medical-ethics/paternalism-soft-hard-and-why-it-declined/) - [**Professionalism and the virtues of a doctor** Professionalism is a doctor's commitment to patients, colleagues and society, beyond knowing…](https://durgical.com/en/medical-ethics/professionalism-and-the-virtues-of-a-doctor/) - [**The common morality, particular moralities and professional ethics** Some moral norms are shared by almost everyone; each group, medicine included, adds rules of its…](https://durgical.com/en/medical-ethics/the-common-morality-particular-moralities-and-professional-ethics/) - [**The five focal virtues of the doctor and the ideal physician** Compassion, discernment, trustworthiness, integrity and conscientiousness are the virtues most…](https://durgical.com/en/medical-ethics/the-five-focal-virtues-of-the-doctor-and-the-ideal-physician/) - [**The four principles of bioethics (principlism)** Four principles help frame an ethical problem in medicine: respect autonomy, do good, do no harm…](https://durgical.com/en/medical-ethics/the-four-principles-of-bioethics/) - [**The history of medical paternalism: from Hippocrates to Percival** For centuries the doctor decided for the patient and hid the truth «for their own good»; that…](https://durgical.com/en/medical-ethics/the-history-of-medical-paternalism-from-hippocrates-to-percival/) - [**Weighing risks, benefits and costs: cost-effectiveness** Comparing benefits with risks and costs is part of doing good; economic analyses help, but they…](https://durgical.com/en/medical-ethics/weighing-risks-benefits-and-costs-cost-effectiveness/) ## Procedure - [**How to work through an ethics case: four boxes and deliberation** An ethics case is worked through in order: first the clinical facts, then the patient's wishes…](https://durgical.com/en/medical-ethics/how-to-work-through-an-ethics-case-four-boxes-and-deliberation/) - [**The deliberative method, step by step** Deliberating means analysing a case on three levels, facts, values and duties, to choose the…](https://durgical.com/en/medical-ethics/the-deliberative-method-step-by-step/) ## International document - [**Oaths and codes: Hippocrates, the Declaration of Geneva and the Colombian oath** The Hippocratic oath, the Declaration of Geneva and the oath of Colombia's Law 23 of 1981 sum up…](https://durgical.com/en/medical-ethics/oaths-and-codes-hippocrates-the-declaration-of-geneva-and-the-colombian-oath/) - [**The UNESCO Universal Declaration on Bioethics and Human Rights** In 2005 UNESCO adopted 15 principles of bioethics addressed to States, linking medical ethics…](https://durgical.com/en/medical-ethics/the-unesco-universal-declaration-on-bioethics-and-human-rights/) - [**The WMA Declaration of Lisbon on the rights of the patient** The Declaration of Lisbon (1981) is the list of patients' rights that the World Medical…](https://durgical.com/en/medical-ethics/the-wma-declaration-of-lisbon-on-the-rights-of-the-patient/) - [**The WMA International Code of Medical Ethics** The WMA International Code of Medical Ethics (1949, revised in 2022) sets out in 40 paragraphs…](https://durgical.com/en/medical-ethics/the-wma-international-code-of-medical-ethics/) ## A to Z - [A](https://durgical.com/en/medical-ethics/a-z/a/) - [B](https://durgical.com/en/medical-ethics/a-z/b/) - [C](https://durgical.com/en/medical-ethics/a-z/c/) - [D](https://durgical.com/en/medical-ethics/a-z/d/) - [E](https://durgical.com/en/medical-ethics/a-z/e/) - [F](https://durgical.com/en/medical-ethics/a-z/f/) - [G](https://durgical.com/en/medical-ethics/a-z/g/) - [H](https://durgical.com/en/medical-ethics/a-z/h/) - [I](https://durgical.com/en/medical-ethics/a-z/i/) - [J](https://durgical.com/en/medical-ethics/a-z/j/) - [K](https://durgical.com/en/medical-ethics/a-z/k/) - [L](https://durgical.com/en/medical-ethics/a-z/l/) - [M](https://durgical.com/en/medical-ethics/a-z/m/) - [N](https://durgical.com/en/medical-ethics/a-z/n/) - [O](https://durgical.com/en/medical-ethics/a-z/o/) - [P](https://durgical.com/en/medical-ethics/a-z/p/) - [Q](https://durgical.com/en/medical-ethics/a-z/q/) - [R](https://durgical.com/en/medical-ethics/a-z/r/) - [S](https://durgical.com/en/medical-ethics/a-z/s/) - [T](https://durgical.com/en/medical-ethics/a-z/t/) - [U](https://durgical.com/en/medical-ethics/a-z/u/) - [V](https://durgical.com/en/medical-ethics/a-z/v/) - [W](https://durgical.com/en/medical-ethics/a-z/w/) [← Medical ethics and health law](https://durgical.com/en/medical-ethics/) Educational content on ethics and health law; 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Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal. Representative model, for educational purposes only. --- Source: https://durgical.com/en/medical-ethics/areas/foundations/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/areas/foundations/