Autonomy in this context may be defined as the right of individuals to make decisions on their own behalf. While most societies have long recognised a basic moral obligation to respect each person's autonomy, it is only relatively recently that this ethical principle has evolved to be of such central importance in the doctor-patient relationship. 

Beneficence is defined as the duty to do the best for the individual patient. Even this relatively straightforward obligation is being challenged at various times and from different quarters. These challenges include such matters as who is to decide what is best, an issue of autonomy, and the availability of the required resources, an issue of justice. 

Non-maleficence is defined as the duty to do no harm. This also appears to be a relatively straightforward moral obligation and probably is the ethical principle best understood and most widely adhered to in clinical practice. However, as medical inventiveness yields new techniques and new diagnostic tests, subtle potential breaches of this obligation are not readily identified by enthusiastic innovators, as may be seen with the premature promotion of new tests for population screening or 'earlier' diagnosis for a variety of ailments. 

Justice is more difficult to define but incorporates notions of equity and fair distribution. While it may be tempting for doctors to shun this obligation, leaving it to managers, administrators and government, this is neither realistic nor desirable. Increasingly, however, the latter groups will be seen to arbitrate between the claims and counter-claims for resources of various specialist groups. This ethical principle emphasizes that the doctors have a responsibility to the community at large as well as to individual patients.

These four ethical 'pillars' do not stand on their own, but are interpreted and applied using two broad systems of reasoning or thinking about ethical principles which have been evolved by philosophers. Doctors trained in the scientific method, where hypothesis is refuted by factual observation, are often uncomfortable with the approaches of moral philosophers, although subconsciously or unknowingly they themselves use these approaches to problems. The two major schools of reasoning are the consequentialist and the deontological. When applied to medical ethical problems, they can be regarded as frameworks for making value judgments. Their importance in the study of medical ethics is to clarify how value judgments are being made and by whom, i.e. in its starkest relief, are doctors applying their own value judgments and ignoring those of patients or the community?

The best known consequentialist school of moral thinking is utilitarianism, expressed crudely as the end justifying the means. Utilitarianism was described by the English philosopher Jeremy Bentham towards the end of the eighteenth century. Bentham proposed that actions be evaluated by their ability to produce pleasure (moral good) or pain (moral evil). In its present form, utilitarianism finds expression in terms of an action's ability to best satisfy all those affected by the proposed action; it involves examining the actions and not the motives or thoughts behind the action.

Conversely the deontological approach centres on the motivation behind the action, according absolute moral values to actions. The ten commandments are a well known deontological set of values, albeit religiously founded, but other deontological codes have been developed which do not have a religious basis, for example that developed by the German philosopher Kant in the eighteenth century. The deontological approach, based on absolute moral values, is almost certainly a significant factor in the personal moral judgments made by most doctors. When these personal values conflict with requests for treatments which are legal, difficulties may arise, as for example requests for sterilization or abortion to a doctor who views such procedures as morally unacceptable. In this type of situation, the doctor should inform the patient of the personal conflict and advise the patient that such treatment should be sought from another doctor. Doctors must refrain from overt moral judgments of patients who are fully entitled to their own set of moral values. . .

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