J Med Ethics 34:141-145 doi:10.1136/jme.2006.018747
  • Clinical ethics

Medical ethics for children: applying the four principles to paediatrics

  1. P Baines
  1. Dr P Baines, Paediatric Intensive Care Unit, Royal Liverpool Children’s Hospital, Eaton Rd, Liverpool L12 2AP, UK; pbb{at}
  • Received 21 July 2006
  • Revised 20 November 2006
  • Accepted 21 November 2006


I will argue that there are difficulties with the application of the four principles approach to incompetent children. The most important principle – respect for autonomy – is not directly applicable to incompetent children and the most appropriate modification of the principle for them is not clear. The principle of beneficence – that one should act in the child’s interests – is complicated by difficulties in assessing what a child’s interests are and to which standard of interests those choosing for children should be held. A further problem with the four principles approach is that parental authority does not follow clearly from the four principles.


  • Competing interests: None.

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