Box 1.

Principlism

All of the principles must be satisfied for an action to be ethical:
  • Benefits: the action is likely to result in a good outcome

  • Burdens and risks: the action must avoid adverse or unwanted effects, risks, inconvenience, debility or these must be proportionate to, and justified by, the good that results

  • Autonomy: we must respect the right for an individual (with mental capacity) to make choices for themselves, including balancing likely benefits and burdens, even if the choice appears to be unwise. Autonomy is exercised through the giving or withholding of consent

  • Justice: we must avoid discrimination on the basis of age, gender, race, disability or other characteristics irrelevant to the decision, and we must work equitably within limited resources