Clinical meaning
Building on the principles of autonomy and beneficence, the NP must also integrate NONMALEFICENCE and JUSTICE into clinical practice. NONMALEFICENCE ('first, do no harm' -- primum non nocere) obligates the NP to avoid causing unnecessary harm to patients. This principle extends beyond obvious physical harm to include psychological harm (e.g., insensitive disclosure of bad news), harm through omission (e.g., failure to order indicated screening), iatrogenic harm (e.g., polypharmacy, unnecessary procedures), and harm from premature diagnostic closure (e.g., anchoring on an incorrect diagnosis). The principle of DOUBLE EFFECT is a critical ethical framework for the NP: an action with both a good effect (intended) and a bad effect (foreseen but unintended) is ethically permissible when: (1) the action itself is not intrinsically wrong, (2) the good effect is intended and the bad effect is merely foreseen (not intended), (3) the bad effect is not the means by which the good effect is achieved, and (4) there is proportionate reason -- the good outweighs the bad. The classic clinical application is palliative sedation: administering opioids/sedatives to relieve intractable suffering (good effect) while...