Art of Medicine
Jul 2018

Balance of Principles

Karl Lorenzen
AMA J Ethics. 2018;20(7):E664-667. doi: 10.1001/amajethics.2018.664.


Each work in this collection explores, from patients’ or their loved ones’ points of view, balance between patients’ experiences and one or more of 4 well-known principles of ethics in health care.

Figure 1. Portrait



Graphite on paper.


Patients can be frightened by clinical instruments in close proximity to their faces. The principles of nonmaleficence and beneficence suggest the importance of both minimizing fear as a source of harm and cultivating the hope of good outcomes in specific clinical encounters. Once maxillofacial or dental pain is alleviated, for example, some grateful patients might offer flowers to staff; a rose is a symbol of beauty and impermanence, a reminder of benefits’ triumph over the risks and fears endured to achieve good outcomes.



Figure 2. Some Other Spring

Some Other Spring


Graphite on paper.


Chemotherapy is considered treatment in the best interests of a cancer patient. Although a patient might choose chemotherapy autonomously, antinausea medication is needed to make the benefits of treatment tolerable. In this drawing, a patient’s iatrogenic hair loss meant her curlers were put aside for a while. The wood beads and straw necklace symbolizes body adornment: it is an attempt to salvage the self-esteem lost with the hair.



Figure 3. At Last

At Last


Graphite on paper.


A justice concern is that patients without insurance or adequate insurance must wait awhile to save enough to have dental work done. When the opportunity arises, at last, they can be relieved of pain or discomfort. Health insurance for a person who is ill is like a pencil sharpener for a pencil: without it, a person needing medical treatment, like an unsharpened pencil, might not function well. The balloon weight is a symbol of festivity: patients “celebrate” obtaining health insurance (“at last!”). And the sprig of baby’s breath signifies purity and freedom from corruption.


AMA J Ethics. 2018;20(7):E664-667.



Conflict of Interest Disclosure

The author had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.