Ethics
High-Yield Summary
- Clinical medicine's four tenets: beneficence (act in the patient's interest), nonmaleficence (do no harm), autonomy (respect patient decisions), justice (fair treatment/resource distribution).
- The Belmont Report (1979) established research ethics' three-principle framework, written in direct response to the Tuskegee Syphilis Study.
- Belmont's three principles: respect for persons (autonomy, informed consent, confidentiality), justice (fair subject selection and benefit distribution), beneficence (maximize benefit, minimize harm).
- "Justice" and "beneficence" appear in both frameworks but mean something different in each.
Clinical Medicine's Four Ethical Tenets
- Beneficence
- The obligation to act in the patient's best interest (e.g., recommending a life-saving surgery despite some risk).
- Nonmaleficence
- "Do no harm" — avoid interventions where potential harm outweighs potential benefit.
- Autonomy
- Respecting a patient's right to make their own healthcare decisions, including declining treatment; underlies informed consent.
- Justice (clinical)
- Treating similar patients with similar care and distributing resources fairly (e.g., allocating scarce organs by medical need, not socioeconomic status).
The Belmont Report's Three Principles (Research Ethics)
- Respect for persons
- Respecting autonomy, ensuring informed consent, protecting confidentiality — with extra care for vulnerable populations (children, cognitively impaired) who can't fully consent.
- Justice (research)
- Which questions are worth pursuing and how subjects are selected — study benefits must be distributed fairly, and vulnerable groups must not be exploited.
- Beneficence (research)
- Maximize potential benefits while minimizing harm.
Common MCAT Trap
- Clinical justice = fair resource allocation to patients. Belmont's research justice = fair selection of subjects and fair distribution of a study's benefits. Same word, different scope — don't answer with the wrong framework's definition.
- The Belmont Report has 3 principles (not 4) and applies to research, not clinical practice — don't merge it with the clinical four-tenet list.
Quick Recall
A doctor honors a competent patient's decision to refuse a life-saving treatment. Which clinical tenet?
Which document established the three-principle research ethics framework, and why?