A focus on the principle of beneficence directs us to look at what does the most good. This focus is often framed in terms of looking at what a specific course of action does to promote an individual’s best interests.
Respect for autonomy means that an individual patient can (and often does) make choices that are not aligned with what might seem to be their best interests, but in the absence of such direction from a patient it is generally assumed that health care decisions should promote best interests (which are generally presumed to be, at minimum, continued life, having basic needs met, and functioning in society).
Beneficence is especially relevant in decision making with individuals who for whatever reason lack capacity; for example, parents are held to a best interest standard when their decision making on behalf of their children is being assessed.
Individuals with capacity are seen as the best judges of what is in fact in their best interest,...
Justice is a principle that is concerned with the distribution of benefits and burdens amongst individuals and groups and with disparities that are not justified by some other principle. Broadly speaking, justice is synonymous with fairness and in health care we are often concerned with justice across a range of domains. We think of justice in the context of individual interactions, but also in terms of the way that social systems and structures treat groups of people.
Justice is concerned with identifying unfairness, that is, differential treatment or outcomes that are not justified by an ethically relevant difference, but it is also oriented to rectifying these discrepancies.
Justice can be reflected in a range of arrangements - sometimes equality (treatment of everyone in the same manner) is the focus, while sometimes equity (treatment that recognizes differences in starting place or background resources) is more appropriate....
Respect for autonomy is a principle that directs us to value and place emphasis on choices that reflect core values or other beliefs that are important to individuals.
In the current political and legal context in Western cultures, respect for autonomy often functions as a trump card.
Respecting autonomy is not simply about respecting choice per se, but emphasizes the importance of respecting choices that reflect deep values. Fostering autonomy is also attentive to the range of available options, and is concerned with people having access to options that reflect what their core values. Concerns about justice are relevant to his, in terms of examining the range of options open to an individual.
Respecting autonomy does not entail a requirement to justify choices; we generally expect that choice should follow rationally from values or principles and the facts of the matter, but there’s a bedrock about choice being what someone who has capacity wants (Lantos).
Respect for autonomy is reflected in the requirement...
