The principles are
- beneficence,
- non-maleficence,
- autonomy,
- justice;
- truth-telling and
- promise-keeping.
Beneficence
The obligation to produce benefit, for individual patients or clients, as we have implied above, is intimately connected to non- maleficence. Its apparently self- evident importance marks it out as the other core principle within the Hippocratic tradition: physicians should heal and help their patients, according to the physician’s abilities and judgment
Non-maleficence
The principle of non-maleficence – do no harm – asserts that a health care professional should act in such a way that he or she does no harm, even if her or his patient or client requests this . This principle is the first to be proposed because of its historical antecedence; it is related to the famous Hippocratic ‘primum nil nocere’– first of all, do no harm’ of medical ethics, although not identical to it.
Health maximisation
Non-maleficence and beneficence can be understood in both deontological and consequentialist terms. Yet as principles they do not seem to go to the core of public health values. This is at least partly because of their tendency to be associated with, and used in trying to analyse, individual professional-client encounters. Even when following beneficence and non-maleficence in these individual encounters, it does not necessarily mean that population health is maximised, as the population is not at all within the focus of these micro- encounters. In the field of public health, the primary end sought is the health of the broader constituency of the public and improvements to this are the key outcome used to measure success
Efficiency
There will always be more health need than resources to deal with that need. Literally all public health systems (and health care systems) worldwide lack resources. These two statements prompt the advocacy of a moral duty to use scarce health resources efficiently. This duty exists at least partly because efficient use will enable public health professionals to produce more health benefit for greater numbers of people. So a moral principle of efficiency would demand, for example, the use of the evidence base and the performance of cost-benefit analyses to decide what should be done and how to do it.
Justice
It is equally possible to conceive of the principle of justice (sometimes ‘social justice’) as having grounds in the fundamental value of human autonomy. Because as humans we all have (or should have) autonomy, we all have (or should have) equal moral worth. Thus, proposals for the unequal treatment of people again require the burden of proof. Justice, to the contrary, demands equal opportunities. This also includes a fair distribution of health outcomes in societies, which is often discussed in terms of public health as ‘health equity’. In a very prominent conception of justice in the context of health, Daniels considers health equity thus a matter of fairness and justice. Under Daniels’ conception of justice, health inequalities are unfair and unjust – and thus in conflict with health equity – if the socially controllable factors that lead to health are not distributed in such a way that the health of all citizens is protected or restored as much as possible.
Respect for autonomy
The paternalistic benevolence contained in the principles of non-maleficence and beneficence is strongly tempered by the emphasis on respect for the autonomy of the patient who the health care professional is seeking to serve.
Proportionality
Our seventh and final principle differs somewhat from those preceding it. As a principle, proportionality is certainly normative. It demands that in weighing and balancing individual freedom against wider social goods, considerations will be made in a proportionate way.