Ethical issues in hospital medicine Vijay Rajput, MD, DPhil, FACP a,b, * , Carolyn E. Bekes, MD, MHA, FACP, FCCM a,b a Division of General Internal Medicine, UMDNJ-Robert Wood Johnson Medical School, Camden, NJ 08103-1489, USA b Cooper Health System, One Cooper Plaza, Camden, NJ 08103-1489, USA Ethics is the application of values and moral rules to human activities. Bioethics applies ethical principles and decision making to solve actual or anticipated dilemmas in medicine. Much like clinical practice, which relies on general rules and case-based experiences, bioethical reasoning relies on learned and accepted moral rules, prior bioethical decisions derived from thoughtful reflection, and unique factors in each individual situation. This method of case-based reasoning is termed casuistry, although physicians better know it as clinical reasoning [1]. The term ethics in this article refers to normative ethics, a type of practical activity through which we try to determine what we ought to do and how our institutions should function. Contemporary medical ethics is a tapestry that interweaves a range of philosophical theories. The following four clusters of moral ‘‘principles’’ are central to medical ethics: (1) autonomy (respecting the decision-making capacities of individuals), (2) nonmaleficence (avoiding the causation of harm), (3) beneficence (providing benefits and balancing benefits against risk and costs), and (4) justice (the fair distribution of benefits, risks, and costs). Historically, nonmaleficence and beneficence have played a central role in medical ethics, whereas respect for autonomy and justice were neglected in traditional medical ethics but have come into prominence in the last 30 years [2]. Autonomy is the most significant value that has been promoted by con- temporary medical ethics. The acknowledgment of autonomy has served to discredit medical paternalism and has led to the promotion of the patient from recipient of treatment to being the partner in a treatment plan. How- ever, the acceptance of autonomy as the benchmark of good has led us to Med Clin N Am 86 (2002) 869–886 * Corresponding author. E-mail address: rajputvk@umdnj.edu (V. Rajput). 0025-7125/02/$ - see front matter Ó 2002, Elsevier Science (USA). All rights reserved. PII:S0025-7125(02)00013-5