Overview

Three of the four core bioethical principles. Beneficence = actively do good (advocate, comfort, educate). Nonmaleficence = first, do no harm (prevent injury, question unsafe orders, weigh risk vs benefit). Justice = fair, equitable distribution of care and resources regardless of socioeconomic status, race, diagnosis, or personal feelings. When principles collide, the nurse identifies the conflict and escalates — you do not resolve ethical dilemmas alone.

Interpretation

The three principles can pull in opposite directions and a beneficial treatment may carry significant harm. Proportional reasoning resolves the conflict: benefit must outweigh burden, and 'benefit' is defined by the client's own values, not the provider's clinical judgment alone.

Beneficence vs Nonmaleficence vs Justice

BeneficenceNonmaleficenceJustice

Core dutyDo good / act in best interestDo no harm / avoid injuryFairness / equitable distribution

Clinical actionAdvocate for effective treatment & comfortQuestion an unsafe order; withhold high-risk careAllocate scarce resources & staff by clinical need

NCLEX scenarioEducate to promote healthBurden of treatment outweighs marginal benefitTriage by acuity, not by who is most vocal

Beneficence

Core duty: Do good / act in best interest
Clinical action: Advocate for effective treatment & comfort
NCLEX scenario: Educate to promote health

Nonmaleficence

Core duty: Do no harm / avoid injury
Clinical action: Question an unsafe order; withhold high-risk care
NCLEX scenario: Burden of treatment outweighs marginal benefit

Justice

Core duty: Fairness / equitable distribution
Clinical action: Allocate scarce resources & staff by clinical need
NCLEX scenario: Triage by acuity, not by who is most vocal

Core Principles

Autonomy

client's right to self-determination; often competes with beneficence when a client refuses 'good' care

Veracity

truthfulness; do not withhold honest clinical information

Fidelity

keeping promises & loyalty; not a synonym for beneficence

Confidentiality

protect private client information

Equity over equality

justice gives more resources to greater clinical need, not identical care to all

Patient Teaching

Center the client's values

'benefit' is defined by what the client wants, e.g. good days over more days

Verify current wishes

prior documented preferences may have changed — confirm before acting on them

Facilitate stakeholder dialogue

clarify treatment wishes with client and family rather than imposing a hierarchy

Report Nowescalate immediately

Unresolvable ethical conflict

principles collide and the team cannot agree — consult the ethics committee

Harmful demand from family

insistence on treatment that increases suffering without meaningful benefit

Justice / resource-allocation dilemma

scarce bed, staff, or resource conflict — escalate, document, do not decide solo

Unequal care by client characteristics

bias-driven unequal treatment is a justice violation — report it

Clinical Pearl

Think BNJ — Benefit the client, Never harm, Judge fairly; and remember autonomy often competes with beneficence when a client refuses what's 'good' for them. When two principles collide, escalate to the ethics committee — never decide alone.

Beneficence, Non-Maleficence & Justice

Overview

Interpretation

Core Principles

Patient Teaching

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.

Key Distinctions

Clinical Pearl

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