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European Observatory on Health Systems and Policies

Ethical principles in health system decision-making

The goals outlined above reflect the underlying ethical principles common to many health systems. Four ethical principles in particular are usually specified in health system decision-making:

  • Respect for autonomy: Recognising the rights of individuals to make informed, independent choices about healthcare, health promotion, and health protection. This leads to the concept of ‘patient choice’. The ethical principle of respect for autonomy cannot, however, be applied universally or regardless of other social values.
  • Non-maleficence (‘not doing harm’): An obligation not to inflict harm (either physical or psychological). As any treatment or intervention can potentially have adverse consequences, it may be necessary to balance the benefits and harms (risks) when deciding whether an intervention is appropriate.
  • Beneficence (‘doing good’): An obligation to benefit individuals is closely related to non-maleficence. As no clinical or public health intervention is always beneficial for everyone, it is the balancing of benefits and harms that is usually more relevant.
  • Justice: The provision of services in a fair and appropriate manner. This is a particular problem in healthcare because of the inevitable mismatch between demands and resources. There are two models of justice that relate to the fair and appropriate allocation of resources (called distributive justice), though there is no current consensus regarding which of these two models is best for decision making.