The Four-Quadrant Approach to Ethical Issues in Burn Care

AMA J Ethics. 2018 Jun 1;20(1):595-601. doi: 10.1001/journalofethics.2018.20.6.vwpt1-1806.


Burn injuries raise questions about decision-making capacity, informed consent, medical decision making, patient autonomy, the patient-physician relationship, and medical futility that must be acutely addressed. A commonly used approach to managing ethical challenges focuses on moral principles including respect for patient autonomy, beneficence, nonmaleficence, and justice. Another paradigm for ethical analysis is the "four-quadrant" approach, which poses questions for a given case regarding medical indications, patient preferences, quality of life, and contextual features. We have found this approach to be very effective in the clinical setting. This article will highlight the use of the four-quadrant approach in the management of ethical challenges that arise in the care of the severely burned patient.

MeSH terms

  • Bioethical Issues*
  • Burns / therapy*
  • Decision Making / ethics*
  • Ethical Analysis / methods*
  • Ethics, Medical*
  • Humans
  • Medical Futility / ethics
  • Mental Competency
  • Patient Care / ethics*
  • Patient Satisfaction
  • Physician-Patient Relations / ethics
  • Quality of Life