Module 1: Professional Accountability and Prescribing

Lesson 6

Principles of the four topic approach

The four topics approach for ethical decision-making is based on the biomedical principles of respect for autonomy, nonmaleficence, beneficence and justice

Principles of Bioethics Definition (adapted from Beauchamp & Childress, 2013)
Respect for Autonomy Patient has the capacity to act intentionally without controlling influences that would mitigate a free and voluntary act.  The patient has the right to decide upon treatment, to assent to a treatment plan, or refuse treatment. This principle is further developed by concepts of competency and informed consent.
Nonmaleficence Asserts an obligation not to inflict harm on another either by acts of commission or omission. This principle requires us to provide a proper standard of care supported not only by our moral values but also the laws of society and our scope of practice. It affirms the need for competence and commits us to protect our patients from harm.
Beneficence Duty to be of benefit to the patient.  This principle implies that the suffering patient (patient) enters into a relationship with one whom society has licensed (RN, NP) as competent to provide care trusting that the RN or NP will help them. This principle can be applied to the individual patient or society at large (Harm reduction programs).
Justice Fair distribution of goods and services.  There are two forms distributive and compensatory justice.

  • Distributive: proper distribution of social benefits and burdens across society.
  • Compensatory: providing payment for harm that has been done to an individual or group.