Medical Ethics Autonomy Beneficence NON Maleficence Justice

Meet the patient

A 58-year-old man with a bleeding duodenal ulcer, a haemoglobin of 45 g per litre, and a deep faith — he is a Jehovah's Witness and refuses all major blood products. Without transfusion he will probably die tonight. The registrar wants to override him "in his best interests."[2]

Your move in the next ten minutes decides whether you commit an assault or honour a death. The stem tests all four principles at once, and the first question is always the same — does he have capacity for this decision?[5]

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1. [1]Shetty N Medical Ethics and Law Indian journal of orthopaedics, 2023.PMID 37881274
2. [2]Druml C, Ballmer PE, Druml W et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration Clinical nutrition (Edinburgh, Scotland), 2016.PMID 26923519
3. [3]Iyalomhe GB Medical ethics and ethical dilemmas Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 2009.PMID 19485140
4. [4]Beauchamp TL Methods and principles in biomedical ethics Journal of medical ethics, 2003.PMID 14519835
5. [5]Dowie I Important legal principles of consent and mental capacity British journal of community nursing, 2024.PMID 38963268
6. [6]Roberts LW Informed consent and the capacity for voluntarism The American journal of psychiatry, 2002.PMID 11986120
7. [7]Lara MC, de la Fuente JR On informed consent Bulletin of the Pan American Health Organization, 1990.PMID 2073557
8. [8]Young GB Ethics Bailliere's clinical neurology, 1996.PMID 9117081
9. [9]Mbonde A, Young MJ, Dmytriw AA et al. Informed consent practices for acute stroke therapy: principles, challenges and emerging opportunities Journal of neurology, 2024.PMID 37815578