The Four Pillars of Medical Ethics

The four pillars of medical ethics — autonomy, beneficence, non-maleficence, and justice — were systematised by Tom Beauchamp and James Childress in their landmark text Principles of Biomedical Ethics (first published 1979). This framework is the single most important ethical model for SJT preparation.

This lesson explores each pillar in depth, examines how they conflict with one another, and provides a decision-making framework for resolving these conflicts in SJT scenarios.

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The Framework at a Glance

Pillar	Core question	SJT relevance
Autonomy	Is the patient's right to choose being respected?	Consent, confidentiality, patient refusal
Beneficence	Is this action in the patient's best interest?	Treatment decisions, going the extra mile
Non-maleficence	Could this action cause harm?	Patient safety, recognising limits, reporting errors
Justice	Is this fair to all parties?	Resource allocation, equal treatment, non-discrimination

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Pillar 1: Autonomy — Respecting Self-Determination

The Principle