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# Ranking the principles: Gracia's two levels (ethics of minimums and maximums)

- Theory

Gracia ranks the four principles on two levels: not harming and fairness bind everyone; autonomy and beneficence depend on each person.

Updated Nov 5, 2026

## Key points

- Level 1, ethics of minimums: nonmaleficence and justice (public, enforceable for everyone).
- Level 2, ethics of maximums: autonomy and beneficence (private, shaped by each person's life plan).
- In a conflict between levels, level 1 prevails.
- It is a critique of principlism, which gives the four principles equal weight.
- It is a classic topic of the Spanish MIR bioethics exam.

## What it is

The Spanish bioethicist Diego Gracia proposed ranking the four principles on two levels instead of giving them equal weight. The first level, the ethics of minimums, groups nonmaleficence and justice: they are public duties, the same for everyone, enforceable even by law, and binding whatever the parties wish. The second level, the ethics of maximums, groups autonomy and beneficence: they belong to private life, to each person's life plan and values. In a conflict, the first level prevails over the second. His method of deliberation uses this ranking to choose a course of action.

## Core ideas

- Minimums are what a society can demand of everyone equally, including through law.
- Maximums are what each person pursues according to their values and idea of a good life; they cannot be imposed.
- Not harming and not discriminating bind even if the patient or family ask for something else.
- Beneficence, in this scheme, depends on what the patient considers good for their life, which is why it goes with autonomy.

## In clinical practice

- If a family asks to «do everything» with a futile treatment that only harms, nonmaleficence (level 1) prevails over their wish (level 2).
- If two options are reasonable and neither harms nor is unfair, the patient decides by their own values (level 2).
- Justice (level 1) allows limiting a scarce resource by institutional rules, even if a patient asks for it.
- The ranking is used inside deliberation: first the facts, then the values, then the duties.

## Criticisms and limits

- Critics: some argue that ranking the principles in advance can make judgement rigid in very particular cases.
- The ranking does not replace deliberation: it helps order things, but the specific case still calls for prudence.

## Test yourself

Think of the answer, then tap the question to see it.

## Which principles make up the ethics of minimums in Gracia's scheme?

Nonmaleficence and justice (level 1).

## Which principles make up the ethics of maximums?

Autonomy and beneficence (level 2), tied to each person's values and life plan.

## If a level 1 principle clashes with a level 2 principle, which prevails according to Gracia?

The level 1 principle (nonmaleficence or justice), because these are public duties that bind everyone.

## Why can the ethics of minimums be enforced by law but not the ethics of maximums?

Because minimums are the same for everyone and protect each person; maximums depend on each person's private values.

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## Connections

## Related 1

- [The four principles of bioethics (principlism)](https://durgical.com/en/medical-ethics/the-four-principles-of-bioethics/)

[← All of medical ethics](https://durgical.com/en/medical-ethics/)

Educational content on ethics and health law; not legal advice. 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.

Sources: [Limits of life and ethical imperatives: a synthesis between principlism and moral deliberation in periviability](https://www.elsevier.es/en-revista-clinics-22-articulo-limits-life-ethical-imperatives-a-S1807593226001596) (Clinics (Elsevier), 2026); [¿Qué es la deliberación en clínica? (Comprender los cuidados paliativos)](https://www.secpal.org/wp-content/uploads/2022/04/secpal-comprender-cuidados-paliativos-5-deliberacion-clinica.pdf) (Sociedad Española de Cuidados Paliativos (SECPAL), 2022).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/ranking-the-principles-gracia-s-two-levels/