Beneficence, Non-Maleficence & Justice

When two patients need the last ICU bed, your decision isn't about preference — it's about justice. Knowing which ethical principle governs which dilemma changes your NCLEX answer.

Beneficence, nonmaleficence, and justice are three of the four core bioethical principles (the fourth, autonomy, is covered separately). Beneficence means actively doing good — advocating for a treatment that benefits the patient, providing comfort measures, or educating to promote health. Nonmaleficence means "first, do no harm" — preventing injury, questioning an unsafe order, or withholding an intervention whose risks clearly outweigh benefits. Justice means fair and equitable distribution of resources and care regardless of socioeconomic status, race, diagnosis, or personal feelings. On the NCLEX, justice questions often involve triage, resource allocation, or treating all patients with equal standards. These principles can conflict: a painful procedure may violate nonmaleficence but satisfy beneficence if the long-term outcome is healing. When principles collide, the nurse identifies the conflict and involves the ethics committee — you don't resolve ethical dilemmas alone.

Key Distinctions

Don't confuse beneficence (doing good) with nonmaleficence (avoiding harm) — they sound similar but pull in different directions when a beneficial treatment carries significant risk. Students often conflate justice with autonomy: justice governs fair allocation across patients, while autonomy governs one patient's right to choose. Fidelity (keeping promises) is a separate concept — it is not a synonym for beneficence.

Clinical Pearl

Think BNJ: Benefit the patient, Never harm, Judge fairly. When an NCLEX scenario pits two principles against each other, the answer usually involves escalation — ethics committee, not solo decision-making.