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    Gillon, Raanan 2015. Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. Journal of Medical Ethics, Vol. 41, Issue. 1, p. 111.

    Akpinar, Aslihan and Ersoy, Nermin 2014. Attitudes of physicians and patients towards disclosure of genetic information to spouse and first-degree relatives: a case study from Turkey. BMC Medical Ethics, Vol. 15, Issue. 1,

  • Print publication year: 2005
  • Online publication date: September 2009

11 - Families and genetic testing: the case of Jane and Phyllis from a four-principles perspective


The four-principles approach does not purport to resolve moral dilemmas!

The four-principles approach in bioethics (beneficence, non-maleficence, respect for autonomy and justice, in case any reader does not already know them – see Beauchamp and Childress 2001 and, for example, Gillon 1994) does not purport to solve moral dilemmas resulting from conflict between the principles and thus it has no canonical response to the moral dilemma(s) presented in the case of Jane and Phyllis. While there are several obvious moral issues raised in this case, and a large variety of others that could reasonably be extracted from it, the main moral dilemma is easy enough to specify. One limb argues reasonably that the confidentiality of Phyllis's medical record should be breached in the interests of providing potential medical benefit to Jane and possibly her daughters – this horn of the dilemma pricks morally because it breaches the moral norm of medical confidentiality. The other limb of the moral dilemma argues reasonably that the strong (even though not absolute) moral norm of respecting medical confidences should be honoured and Phyllis's medical information should therefore not, without her consent, be passed on to Jane – this horn pricks morally because Jane's health, and possibly that of her daughters, may unnecessarily and possibly severely be harmed as a result of the doctors not breaching medical confidentiality.

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Case Analysis in Clinical Ethics
  • Online ISBN: 9780511545450
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Beauchamp, T. and Childress, J. (2001). Principles of Biomedical Ethics, 5th edn. Oxford: Oxford University Press.
British Medical Association., (1998). Human Genetics: Choice and Responsibility. Oxford: Oxford University Press.
Convention for the Protection of Human Rights and Fundamental Freedoms.
General Medical Council., (2000). Guidance on Confidentiality. London: GMC. (Also available on GMC website
Gillon, R., (1985). Philosophical Medical Ethics. Chichester: Wiley, 106–12.
Gillon, R. (1994). Medical ethics: four principles plus attention to scope. BMJ, 309, 184–8.
Gillon, R. (1998). Confidentiality. In Kuhse, H. and Singer, P., eds., A Companion to Bioethics. Oxford: Blackwell, 425–31.
Hare, R. M., (1985). Moral Thinking. Oxford: Oxford University Press.
Universal Declaration of Human Rights. (1948).