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Cited by 124Ethics and bioethics in healthcareEthics in medical practiceMedicine, History, and Philosophy

Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics

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Gillon, Raanan·2015·Journal of Medical Ethics
DOI 10.1136/medethics-2014-102282
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Abstract

Objectives An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. Design The design was an observational prospective study of risk factors embedded in a randomised controlled study. Setting Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres. Participants During a 2-year inclusion period, acute consecutive whiplash-injured (age 18–70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I–III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. Results The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification. Analysis Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies. Conclusions Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed.

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  • A universally accepted hierarchy of principles to prioritise competing norms does not exist.

    “A universally accepted hierarchy of principles to prioritise competing norms does not exist.”

    From Principles alone cannot guarantee ethical AI (2019) · cites this paper as [57]

  • The "Principles of Biomedical Ethics" by Beauchamp and Childress is a commonly applied and well-fitting ethical framework for assessing biomedical ethical challenges, introducing four key principles: autonomy, beneficence, nonmaleficence, and justice.

    “A commonly applied and well-fitting ethical framework when assessing biomedical ethical challenges are the “Principles of Biomedical Ethics” by Beauchamp and Childress [36, 37] introducing four key principles: autonomy, beneficence, nonmaleficence, and justice [36].”

    From Explainability for artificial intelligence in healthcare: a multidisciplinary perspective (2020) · cites this paper as [37]

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  1. JME40: Good medical ethics on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from JME40: Good medical ethics on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from JME40: Good medical ethics on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from JME40: Good medical ethics on July 17, 2023 by guest. Protected by copyright. http://jme.bmj.com/ J Med Ethics: first published as 10.1136/medethics-2014-102282 on 16 December 2014. Downloaded from REFERENCES
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Authors
Gillon, R.
Affiliations
Imperial College London (GB)
Corresponding author
Gillon, Raanan
ORCID
Gillon, Raanan
Venue
Journal of Medical Ethics
Publisher
BMJ
Published
2014-12-16
Volume
41
Issue
1
Pages
111-116
ISSN
  • 0306-6800 (ISSN-L)
  • 1473-4257
DOI
10.1136/medethics-2014-102282
OpenAlex
W2138402220
Cited by
124
References
21
Citations by year
2026: 8 · 2025: 21 · 2024: 13 · 2023: 22 · 2022: 15 · 2021: 14 · 2020: 8 · 2019: 9 · 2018: 4 · 2017: 4 · 2016: 2 · 2015: 4
FWCI
3.30
Type
journal article
Language
en
Update notices
Open access
Locations
  • Journal of Medical Ethics (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
  • Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
Keywords
whiplash-associated disorders, acute whiplash, risk stratification, risk score, work disability, return to work, neck pain, headache, cervical range of motion, sick-listing, risk factors
MeSH terms
Delivery of Health Care, Ethics, Medical, Humans, Morals, Principle-Based Ethics

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