1. Beneficence: the obligation of health care provider to help people in need
2. Nonmaleficence: the duty of health care providers to do no harm
3. Autonomy: the right of patients to make choices regarding their health care
4. Justice: the concept of treating everyone in a fair manner
Ethical dilemmas are situations in which a provider of medical care is forced to .make a decision that violates one of the 4 principles in order to adhere to another.
Example: withdrawing a feeding tube in accordance with a family's wishes chooses autonomy over beneficence.
Example: a Jehovah's Witness refuses a lifesaving transfusion. The resident could give the blood once the JW is unconscious, trading autonomy for beneficence.
Example: the wife of a brain cancer victim wants surgery that wouldn't help. In refusing to do this, the surgeon chooses nonmaleficence over autonomy.
In the late 20th century, a new generation of ethical dilemmas has emerged: money may not be available to pay for a reasonable level of medical services for all people. E.g. should limits be set on people with high-cost medical needs so that other people can receive basic services? Such decisions move beyond the individual physician patient relationship embodied in the 4 principles above to involve the broader society, perhaps a 5th principle (the greater good?)
Rationing: The limitation of resources, including money, going to medical care such that not all care expected to be beneficial is provided to all patients; and the distribution of these limited resources in a fair manner. A conscious policy of equitably distributing needed resources that are in limited supply.