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Article
February 2, 1990

Ethical Principles in Critical Care

Author Affiliations

From the Chest Service of the Department of Medicine, San Francisco General Hospital, and the University of California, San Francisco.

From the Chest Service of the Department of Medicine, San Francisco General Hospital, and the University of California, San Francisco.

JAMA. 1990;263(5):696-700. doi:10.1001/jama.1990.03440050090040
Abstract

THE MOST compelling principle of medical ethics always has been beneficence: acting to benefit patients by sustaining life, treating illness, and relieving pain. A correlative principle is nonmaleficence: refraining from harm. A third principle that has increasingly gained acceptance in the United States is autonomy: respecting the right of patients to determine much of their medical care. Closely related to this is disclosure: providing adequate and truthful information for competent patients to make medical decisions.1-3 A fifth ethical principle is social justice: allocating medical resources fairly and according to medical need.4

The first four ethical principles outlined above are the foundation of the fiduciary relationship in which physicians are expected to serve the best interests of their patients as the patients define these interests. This relationship is relatively easy to maintain when primary physicians follow up patients in their offices or in hospital rooms. However, the relationship may

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