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The Four Pillars Of Medical Ethics (Simply Explained)

The Four Pillars Of Medical Ethics (Simply Explained)

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

The four pillars of medical ethics encompass vital principles that guide every healthcare professional.

These crucial ethical cornerstones address concerns linked to patient care and professional decision-making in every aspect of medicine

Understanding and applying these principles helps healthcare providers navigate the challenging landscape of moral issues they encounter throughout their careers.

I appreciate that medical ethics can be a daunting topic if you’re just getting to grips with it prior to a university or job interview.

However, in this article, I’m going to take you through the framework upon which modern medical ethics is built, as well as a step-by-step plan for answering any ethics interview questions you may come across.

What Are The Four Pillars Of Medical Ethics?

Medical ethics can be defined as a moral code by which all doctors conduct themselves.

Every doctor practices medicine in line with a philosophy. For example, on graduating in the UK every doctor takes the Hippocratic Oath.

Hippocrates (the ancient Greek father of modern medicine) laid out some do’s and don’ts for physicians.

The Four Pillars Of Medical Ethics Pixel Infographic

By taking the oath, you’re promising to practice in line with its principles. The oath in many ways reflects the four pillars of medical ethics:

  1. Autonomy
  2. Beneficence
  3. Non-maleficence
  4. Justice

It’s through using these four pillars as guidance that you can tackle any ethics question they can throw at you at an interview.

Why Are Medical Ethics Important?

Doctors are in a uniquely privileged position as a result of their work.

They’re trusted by patients with their most personal problems, intimate examinations and are consulted for guidance on life-changing decisions.

This trust is given freely by patients because of the confidence in doctors to adhere to ethical codes.

A doctor examining a child's foot
A doctor examining a young boy’s foot

You need to have faith that your doctor is going to act in your best interests, not try and profit from you and won’t go gossiping to the reception staff about what you just told them.

Medicine can only be effectively practised when patients have confidence in medical professionals.

Imagine going to your GP with a stomach ache but refusing to allow them to examine your tummy or take your blood.

This is why it’s so important everything doctors do is aligned with the principles of modern medical ethics.

It’s only by having this common understanding and ethical foundation that allows the doctor-patient relationship to flourish and so enables a physician to practise medicine effectively.

Where Medical Ethics Come From

Medical ethics are nothing new and have been around for almost as long as people have been practising medicine.

The famous Hippocratic Oath, attributed to the Greek physician Hippocrates around 400 BCE, is one of the earliest examples of a formalised code of conduct for medical professionals.

While its principles have evolved over time, the Oath still forms the basis of today’s ethical guiding tenets, including respect for confidentiality, practising medicine for the benefit of the patient, and avoiding harm.

More recent changes include the move away from medical paternalism being a commonly accepted approach to patient care- which has only happened over the last few decades.

Medical paternalism involves the medical practitioner making decisions on behalf of the patient, often based on the belief that the doctor knows best.

As medical ethics evolved, it became evident that this paternalistic approach did not always serve the best interests of the patient.

The principles of autonomy and informed consent then became more prominent, shifting the focus toward patient-centred care and ensuring that patients could make their own decisions about their treatment.

Understanding The Four Pillars Of Medical Ethics

These principles provide a framework for analysing ethical situations in healthcare and guide medical practitioners in making the best decisions for their patients.

Pillar 1: Autonomy

Autonomy: letting the patient make their own decisions

Autonomy refers to the principle of respecting the patient’s right to make their own decisions about their own healthcare.

This means giving the patient the freedom to choose their course of treatment, provided they are capable of making an informed decision.

Informed consent, truth-telling, and confidentiality are essential aspects that arise from this principle, ensuring that patients are well-informed and their privacy is respected.

One example of what this pillar looks like in practice is explaining to a patient all the risks and benefits of the different treatment options open to them.

It’s then up to the patient to decide on a course of action.

The NHS’s ‘No decision about me, without me’ was an initiative by the government to promote shared decision-making between clinicians and patients.

Or put another way, it aimed to strengthen the autonomy of patients treated in the NHS.

LEARN MORE: My in-depth guide to the pillar of autonomy.

Pillar 2: Beneficence

Beneficence: trying to help the patient

Beneficence is the pillar that says doctors should do good for patients- pretty intuitive I know.

But it’s more than just that. It’s about putting the patient at the centre of anything and everything you do, from clinical trials to public health.

It’s a key concept that permeates the entirety of medicine: the patient always comes first.

By keeping this at the forefront of your mind you can’t go too far wrong- whether that be answering an ethics interview question, the UCAT SJT, or indeed clinical practice!

The principle requires medical practitioners to provide appropriate treatments and care, aiming to maximise the benefits while minimising any potential harm.

To fulfil this duty, medical professionals must stay up-to-date and knowledgeable in their field and seek to apply evidence-based practices in all their patient care.

LEARN MORE: My in-depth guide to the pillar of beneficence.

Pillar 3: Non-Maleficence

Non-maleficence: not harming the patient

Non-maleficence is possibly the most famous pillar of medical ethics. It’s the principle of “do no harm”.

It’s sort of the other side of the coin to beneficence- do good for the patient and don’t harm them.

It requires healthcare professionals to avoid causing harm to their patients, whether physical, emotional, or psychological.

This involves carefully considering the potential risks and side effects of treatments, as well as the long-term consequences of their decisions.

Now this harm isn’t always as obvious as a doctor inscribing his initials onto patients’ livers.

It can be more subtle such as the harm caused by unnecessary screening programs.

If you carry out a screening program for an incredibly rare cancer with a test that’s not particularly accurate, you’ll end up telling a huge number of people that they’ve got cancer when they haven’t.

That’s because the test will throw up a large number of false positives- more so than real cancer patients it picks up.

It can then be argued that the grief and further tests you’d put these false-positive patients through can outweigh the good you’re doing for the small number of actual cancer patients you treat.

As you can see, balancing the principles of beneficence and non-maleficence can sometimes be challenging: treatments with potential benefits often carry certain costs or risks.

LEARN MORE: My in-depth guide to the pillar of non-maleficence.

Pillar 4: Justice

Justice: trying to be fair

The principle of justice focuses on ensuring fairness in healthcare provision and resource distribution.

This means treating patients equally, regardless of their social, economic, or cultural background, and providing access to healthcare for everyone.

It’s why NHS healthcare is free to all at the point of delivery.

It’s also why the NHS prioritises patients based on clinical need, not rank, status, or wealth.

Delivering a fair health service to everyone is an extremely thin and difficult line to tread: who’s to say whether resources would be better spent on one child with cancer or one hundred middle-aged people with diabetes?

There are rarely any ‘correct’ answers to these ethical dilemmas.

What the pillar of justice does do however is provide an important reminder about the need for egalitarian healthcare.

In medical practice, this principle is important when making decisions about resource allocation, rationing care, or prioritising patients’ needs.

Justice also extends to the ethical treatment of patients, ensuring that their rights are not violated and their dignity is maintained.

LEARN MORE: My in-depth guide to the pillar of justice.

How Medical Ethics Differ From Law

Medical ethics and law generally share the same goal of ensuring proper conduct within the medical profession. However, they differ in their implementation and scope.

While medical ethics deals with the moral principles guiding physicians’ and healthcare providers’ actions, medical law focuses on creating and enforcing legal statutes that regulate the practice of medicine.

For example, if a doctor were to purposefully harm patients by performing unnecessary operations, they would be breaking both the law and their ethical code.

This would be contrary to the pillar of non-maleficence and in the eyes of the law could be seen as ‘wounding with intent.’

If however, a doctor were to subtly steer a patient to choosing a private treatment option, because the doctor knew they could profit from it, this would be nearly impossible to prosecute under UK law.

Lawyers discussing a medical ethics case

It would however absolutely be against the pillar of beneficence- because the doctor has placed their own interests above the patient’s.

In many cases, ethical principles inform legal regulations, but there are instances where ethical considerations might conflict with legal requirements.

In such situations, healthcare professionals must carefully navigate both ethical and legal standards to make the best decision for their patients.

The 3C’s Of Medical Ethics

As well as the four pillars, when considering ethical scenarios for an interview or otherwise, you should also think about the three Cs:

  1. Capacity
  2. Consent
  3. Confidentiality

They’re not as integral to modern medical ethics as the four pillars but are all incredibly important cornerstones in their own right.

Adding them to your arsenal will allow you to systematically work through ethical dilemmas and score top marks in an interview.

Capacity

In the context of medical ethics, capacity refers to the ability of an individual to understand the relevant information and make informed decisions about their health.

In short, it’s whether someone can think clearly enough to be able to make a sensible decision. It’s deciding if a patient has the mental faculties to process a situation.

A patient might not have capacity if they:

  • Are extremely drunk
  • Have just had a serious head injury
  • Suffer from advanced dementia
  • Have a severe learning disability

You can see how in all these cases the patient’s ability to make thought-out decisions is impaired. In these situations, the aim of doctors is to act in the patient’s best interests.

That is, what they think the patient would want (and is best for them) should their judgement not be impaired.

Assessment of capacity is crucial in ensuring that patients can exercise their right to autonomy.

Healthcare professionals must evaluate a patient’s capacity to comprehend the nature and consequences of the proposed treatment, weigh the benefits against potential risks, and ensure they can effectively communicate their preferences.

LEARN MORE: My in-depth guide to the principle of capacity.

Consent

Consent is a patient giving you permission to do something to them- whether that be taking their temperature or performing an operation.

Without consent, anything you do to a patient could be seen as assault. In medicine, we often talk about informed consent.

That’s because it’s not good enough for a patient to simply give us the go-ahead to do something.

For them to make a balanced decision they have to be aware of both the benefits and risks of whatever it is we want to do.

That’s why if you’ve ever had an operation the doctor will have run through all the things that could possibly go wrong if you went ahead.

Although it was likely the best course of action, you still needed to be aware of them in order to give your informed consent to having the surgery.

It involves providing patients with all the necessary information about a proposed treatment, including its benefits, risks, and available alternatives.

This empowers patients to make voluntary and informed decisions regarding their care, highlighting respect for their dignity and self-determination.

  • Voluntary: Consent must be given freely, without coercion or undue influence from healthcare professionals or family members.
  • Informed: Patients should receive accurate, comprehensive, and easily understandable information about their treatment options.
  • Competent: The patient must have the capacity to comprehend the provided information and make rational decisions based on it.

LEARN MORE: My in-depth guide to the principle of consent.

Confidentiality

Maintaining confidentiality is a cornerstone of the patient-provider relationship, as it promotes trust and encourages honest communication.

It’s the principle that you won’t repeat anything a patient’s told you to anyone not directly involved in their care.

It’s only as a result of patients trusting doctor’s that they’re willing to discuss sensitive medical issues such as their sexual health.

Healthcare professionals must uphold patients’ right to privacy, ensuring that personal and sensitive medical information remains secure and is only disclosed to authorised parties.

Exceptions to confidentiality may arise in cases where there is a risk of harm to the patient, other individuals, or public health. These include cases when:

  • The patient is a risk to themselves e.g. they’ve told you they’re going to kill themselves
  • The patient is a risk to others e.g. they said they’re planning to assault someone
  • Required by law e.g. disclosures to a court or for specific infectious diseases

In such situations, healthcare professionals must carefully weigh the potential consequences and consider the ethical principles involved, including autonomy, beneficence, and justice, before proceeding with the disclosure.

It’s also always best to seek permission from the patient before breaking confidentiality but sometimes it has to be done.

LEARN MORE: My in-depth guide to the principle of confidentiality.

Medical Ethics Theories

Ethical theories are comprehensive systems of principles or frameworks that provide a broad understanding of what is morally right or wrong.

They aim to establish the fundamental principles or guidelines for ethical decision-making and the moral evaluation of actions.

In this section, I’m going to discuss 3 different ethical theories: consequentialism, utilitarianism and deontology.

Ethical principles, on the other hand, are specific guidelines or rules derived from ethical theories that help address particular ethical issues or situations.

These principles serve as practical guidelines to assess and guide moral behaviour in specific contexts. The ethical principles we’ve discussed so far include autonomy, beneficence, non-maleficence and justice.

Consequentialism

Consequentialism is a theory in medical ethics that focuses on the outcomes or consequences of an action rather than the action itself.

The primary goal in consequentialist ethics is to bring about the most favourable outcome for all parties involved.

In healthcare, this can mean considering the potential benefits and harms of a treatment or procedure for both the patient and society.

Utilitarianism

Utilitarianism is a form of consequentialism that seeks to maximise overall happiness or minimise suffering.

In medical ethics, utilitarianism is often used to balance the well-being of individual patients and the overall welfare of society.

It takes into account factors like reducing pain, prolonging life, and improving quality of life to determine the best course of action.

Additionally, utilitarianism may be applied to public health policies and healthcare resource allocation in order to ensure the greatest benefit for the largest number of people.

Deontology

Deontology, on the other hand, focuses on the moral principles and duties that guide actions, rather than their consequences.

In medical ethics, deontological theories emphasise the importance of adhering to certain ethical rules and principles, such as respecting patient autonomy and ensuring non-maleficence.

Deontologists believe that some actions are inherently right or wrong, regardless of their outcomes, and that healthcare professionals have an obligation to practice according to these principles.

How To Answer Medical Ethics Questions

Having now covered the essential theory behind most of medical ethics, I thought I’d finish by looking at how you can tackle ethics questions in a job or university interview.

To begin with, there’s one thing you absolutely must do to score well in a medical ethics question or interview station…

Address both sides of the argument!

So many candidates either run out of time or get caught up under the pressure of the day and only talk about one side. This is a big mistake.

A medicine applicant answering an ethics question

Even if you do run out of time, there’s something you can do to demonstrate you planned to go further: signposting.

Signposting, in this context, is laying out in clear language the points at which you progress through each portion of your response.

So in your introduction, you might say something along the lines of:

“This is clearly a complex case with substantial arguments for both sides. I’m going to first consider the positives to this before moving on to the negatives. I shall then conclude with my opinion on the balance of each argument.”

As you go along you then signpost that you’re now thinking about why this should or shouldn’t be the case (for whatever the scenario is).

By considering both sides of the argument, holding each up to the light of modern medical ethics, your answer is sure to stand out compared to that of other candidates.

Example Medical Ethics Interview Questions

Here are a few examples of medical ethics questions that are frequently discussed and debated at medical school interviews.

  • If a patient refuses life-saving treatment due to personal or religious beliefs, should a doctor still proceed with the treatment against their wishes?
  • Should a doctor recommend a more aggressive treatment with higher risks but potentially better outcomes, or a safer treatment with lower risks but potentially less effective results?
  • If there is only one organ available for transplant, and multiple patients are in urgent need, who should receive it?
  • What are the ethical considerations surrounding the use of experimental treatments or therapies on patients who have exhausted all standard treatment options?
  • When faced with a patient requesting an elective procedure with potential health risks or limited medical necessity (e.g., cosmetic surgery), what ethical considerations should a doctor take into account when deciding whether to provide or refuse the procedure?

These example medical ethics questions showcase the complexities that can arise as healthcare professionals work to uphold the four pillars of medical ethics.

LEARN MORE: My in-depth guide to medical ethics questions.

How To Prepare For Medical Ethics Questions

There are three simple things you can do to prepare well for ethical questions and stations if you’ve got an interview coming up:

  1. Have a good understanding of the principles discussed in the four pillars and 3 C’s sections
  2. Keep up-to-date with any new controversial medical cases and revise interview favourites (abortion, euthanasia, organ donation etc…)
  3. Apply the ethical principles to every practice answer you give

A really great exercise to do is take an ethical dilemma that might come up (e.g. an underage girl coming to request contraception) and then writing out the four pillars and the three C’s.

Then brainstorm as many pros and cons of the scenario for each principle.

Not every scenario or question will be relevant to all the principles.

However, it’s still a fantastic mindset to be in. By mentally referencing all the principles you’re much less likely to miss any glaring points in your real interview.

Final Thoughts

Understanding and applying the four pillars of medical ethics is essential for medical practitioners as they navigate the complex and challenging world of healthcare.

By adhering to these principles, healthcare professionals can make well-informed, ethical decisions that prioritise the well-being and quality of life of their patients.

Medical ethics questions are sadly never going to have an easy answer to them. Otherwise, they wouldn’t bother asking candidates about them at an interview!

But, the silver lining of this is there is rarely a singular correct answer: you’ll probably be able to impress your interviewer on whichever side of the fence you come down on.

Together, the four pillars of medical ethics, drawn from various philosophical and moral traditions, create a valuable framework for healthcare professionals and medicine applicants alike.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.