J Med Ethics 29:307-312 doi:10.1136/jme.29.5.307
  • Paper

Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”

  1. R Gillon
  1. Correspondence to:
 Professor R Gillon, Centre for Primary Care and Social Medicine Ethics Unit, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstan’s Road, London W6 8RP, UK; 
  • Accepted 7 July 2003


It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism.