Measuring the Four Principles of Beauchamp and Childress

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The Four Principles, originally devised by Beauchamp and Childress in their textbook Principles of Biomedical Ethics, are considered by many as the standard theoretical framework from which to analyse ethical situations in medicine. While the validity and scope of the principles are often debated, there is no questioning the canonical status of the four principles in the field of Medical Ethics. Briefly, the four principles are,

  1. Autonomy – The right for an individual to make his or her own choice.
  2. Beneficence – The principle of acting with the best interest of the other in mind.
  3. Non-maleficence – The principle that "above all, do no harm," as stated in the Hippocratic Oath.
  4. Justice – A concept that emphasizes fairness and equality among individuals.

It’s easy to see why the four principles have had such a far-reaching influence in Medical Ethics. The values inherent in the principles clearly resonate with our moral norms, and their practical use in ethical decision making is immediately apparent. As a theoretical framework, the four principles remain as useful today as when they were published over 30 years ago; however, in the same time period, the field has drastically changed.  

Medical Ethics has taken a turn towards empiricism, and empirically measuring the four principles is a key challenge in the new Medical Ethics. Katie Page, from the Queensland University of Technology, has recently published an article in BMC Medical Ethics that attempts to measure empirically the four principles and examines whether the principles can predict applied medical decision making. She discovers that there is a preference of non-maleficence over the other three principles, but that the preference does not translate when used in real-world ethical judgements. Her findings serve as an elegant example of quantifying and refining established philosophical constructs, and her conclusions raise a number of philosophical questions regarding the nature and usefulness of the four principles. 

There is much debate over the relevance of philosophy in current Medical Ethics, but work such as Page’s demonstrates that philosophy and empiricism can integrate in new, enlightening ways, where empiricism is not a threat but rather a tool that refines philosophical constructs and spurs on new discussions of established ideas.