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For those who work in the healing professions, ethical values play a special role. The specific content of medical ethics was first formulated centuries ago, based on the sayings of Hippocrates and others. The refinement of medical ethics has continued up to the present by practicing health caregivers, health professional and religious organizations, and individual ethicists. As medical technology, health care financing, and the organization of health care transform themselves, so must the content of medical ethics change in order to acknowledge and guide new circumstances.

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Over the years, participants in and observers of medical care have distilled widely shared human beliefs about healing the sick into four major ethical principles: beneficence, nonmaleficence, autonomy, and justice (Beauchamp and Childress, 2008) (Table 13–1).

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Table 13–1. The Four Principles of Medical Ethics 
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Beneficence is the obligation of health care providers to help people in need.

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Dr. Rolando Bueno is a hard-working family physician practicing in a low-income neighborhood of a large city. He shows concern for his patients, and his knowledge and judgment are respected by his medical and nursing colleagues. On one occasion, he was called before the hospital quality assurance committee when one of his patients unexpectedly died; he agreed that he had made mistakes in his care and incorporated the lessons of the case into his future practice.

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Dr. Bueno tries to live up to the ideal of beneficence. He does not always succeed; like all physicians, he sometimes makes clinical errors. Overall, he treats his patients to the best of his ability. The principle of beneficence in the healing professions is the obligation to care for patients to the best of one's ability.

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Nonmaleficence is the duty of health care providers to do no harm.

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Mrs. Lucy Knight suffers from insomnia and Parkinson's disease. The insomnia does not bother her, because she likes to read at night, but it irritates her husband. Mr. Knight requests his wife's physician to order strong sleeping pills for her, but the physician declines, saying that the combination of sleeping pills and Parkinson's disease places Mrs. Knight at high risk for a serious fall.

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The modern array of medical interventions has the capacity to do good or harm or both, thereby enmeshing the principle of nonmaleficence with the principle of beneficence. In the case of Mrs. Knight, the prescribing of sedatives has far more potential for harm than for good, particularly ...

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