ABSTRACT
Medical knowledge and technology have advanced at a spectacular rate. This voyage of discovery has led to a wealth of ethical issues unimaginable to the original followers of the Hippocratic oath. Steeped in the history of philosophy and religion, the development of medical ethics has been an attempt to unravel and resolve the moral complexities and dilemmas that have faced doctors through the ages. Several tenets of medical ethics have survived to the modern day – for example, primum non nocere (fi rst do no harm). Other concepts, such as the notion of communal responsibility and justice, have arisen in the complex modern medical era. When faced with an ethical dilemma, a useful starting point for critical refl ection and decision-making is the ‘four principles’ model pioneered by the ethicists Beauchamp and Childress.1 In their classic text Principles of Biomedical Ethics1 they propose that at the heart of moral reasoning in healthcare lie the principles of autonomy, justice, benefi cence and non-malefi cence. This approach has met with some criticism as being too simplistic, but of great appeal is that these prima facie principles offer fl exibility, represent a neutral frame of reference applicable to patients from different cultures and religions and are independent of political doctrines.2
