Four Ethical Principles

The four principles of ethics provides an accessible and culturally neutral approach to thinking about ethical issues in healthcare(1). This approach is based on the four prima facie moral commitments of autonomy, beneficence, non-maleficence and justice(1, 2). It offers a moral, analytical framework for healthcare professionals to aid decisions, when moral issues arise(2). This approach was developed by Beauchamp and Childress in the 1980s to provide a common, moral language for clinicians(1). The term prima facie indicates that a principle is binding unless it conflicts with another moral principle(2, 3). Whilst this approach does not provide a method of choosing between the principles, it provides an ethical framework to follow(1-3).

The legal precedent for informed consent establishes a patient’s right to determine what is done to their body(6). The process of consent protects patients against battery and unwanted medical procedures.(5, 7). Furthermore, it safeguards a patient’s right to autonomy and self-determination.(8) The ethical purpose of informed consent seeks to shift the decision-making away from the clinician and towards the patient(7). The basic elements of informed consent consist of the patient having capacity to decide, the clinician providing evidence of the risks, benefits and alternatives, the patient understanding the information and freely deciding on the treatment or intervention.(9) The literature regarding consent also highlights that it is an active process, therefore, consent can be given or withdrawn at any point in the process(5, 7).

This essay will critically explore the ethico-legal principles of consent from a clinical perspective. This discussion will include the constraints of informed consent within the clinical practice setting and the implications for the patient and the Physician Associate

Clinicians in practice recognise the constraints of informed consent but feel unable to change them due to the limitations of the workplace(12). Doctors interviewed in a study felt they had insufficient training in consent procedures, thus lacking the confidence to effectively carry it out(6, 27). The same study also reported that clinicians do not have sufficient time to practice thorough, informed consent, due to long job lists and short staffing(27). The issues raised by this study determine that consent can become a tick box exercise and a chore to be carried out(26, 27). Consequently, consent can become routine for clinicians with little regard for patients concerns(12). The outcome of this, is little discussion of the risks and benefits of procedures, thus invalidating informed