Principle of bioethics give only the main points relevant to neet pg or inicet

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Principles of Bioethics - High-Yield for NEET PG / INI-CET

The Four Core Principles (Beauchamp & Childress - "Principlism")

Introduced in Principles of Biomedical Ethics (Tom Beauchamp & James Childress, late 1970s). This is the dominant bioethical framework in western medicine.

1. Autonomy (Most tested)

Respects the patient's right to make their own decisions - even refusing treatment
Requires the patient to have decision-making capacity
Basis for: Informed Consent, advance directives, confidentiality
Key rule: "Patient's values drive medical decisions"

Informed Consent - must know these elements:

Element	Detail
Disclosure	Doctor gives adequate information
Understanding	Patient comprehends it
Voluntariness	No coercion
Capacity	Patient is competent to decide
Consent	Patient agrees/refuses

Exceptions to consent: Emergency (implied consent), incompetent patients (surrogate/next of kin), minors (parent/guardian), infectious disease/public health
An adult with capacity CAN refuse life-saving treatment - autonomy prevails

2. Beneficence

"Do good" - act in the patient's best interest
Positive duty: actively benefit the patient
Basis for all treatment and preventive care
Can conflict with autonomy (e.g., patient refuses needed surgery)

3. Non-maleficence

"Do no harm" (Primum non nocere)
Avoid causing unnecessary harm
Basis for: risk-benefit analysis before any intervention
Even well-intentioned actions can violate this (e.g., a procedure with more risk than benefit)
Distinct from beneficence: non-maleficence = passive (avoid harm); beneficence = active (do good)

4. Justice

Fair distribution of health resources and equal treatment
Distributive justice: allocating scarce resources fairly
Includes: treating similar cases similarly, avoiding discrimination
Examples in exams: triage, organ transplant allocation, ICU bed allocation

Key Exam Points (High-Yield)

Concept	What to Know
Ethical dilemma	Conflict between two or more of the 4 principles
Autonomy vs. Beneficence	Classic conflict - e.g., patient refuses blood transfusion
Non-maleficence vs. Beneficence	Every treatment has risk; weigh harm vs. benefit
5th principle (often added)	Confidentiality (Rosen's EM lists it alongside the 4)
Principlism criticism	Favors Western individualism; may not suit communitarian/non-Western cultures

Additional Concepts Frequently Tested

Confidentiality

Patient information must not be disclosed without consent
Exceptions: threat to third parties (e.g., HIV partner notification), notifiable diseases, court orders, child abuse

Veracity (Truthfulness)

Doctor must not deceive the patient

Fidelity

Keep promises, maintain trust in the doctor-patient relationship

Surrogate Decision Making (when patient lacks capacity)

Best interest standard - what is best for the patient
Substituted judgment - what would the patient have wanted

Quick Memory Hook

"A-BNJ" = Autonomy, Beneficence, Non-maleficence, Justice

Or the classic mnemonic: "Aunty Bena Never Judges"

Common Exam Scenarios

Patient refuses dialysis → Autonomy must be respected if capacitated
Jehovah's Witness refuses blood → Autonomy prevails in adults; for minors, court can override
Doctor withholds bad news → Violates autonomy/veracity
Resource allocation in pandemic/triage → Justice principle
Placebo without consent → Violates autonomy + veracity
Treating an unconscious emergency patient without consent → Implied consent (beneficence + emergency exception)
Rosen's Emergency Medicine, Key Concepts
Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Ch. 55.6c

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