How Medical Ethical Principles Translate to Occupational Health Practice

Occupational health professionals work at the intersection of clinical care and the workplace… which can include employment processes. As in any healthcare setting,  one of the foundations of occupational health practice is the application of core medical ethical principles. These principles—autonomy, beneficence, non-maleficence, and justice—guide decision-making, maintain ethical practice and help build trust between individuals, employers, and health professionals.

An understanding of these principles can help HR professionals, managers, and employees better understand the rationale behind occupational health recommendations, especially when the situation or the outcome may feel complex or uncomfortable. All four of the ethical principles below can be applied on an individual and wider population basis. 

The four ethical principles

1. Autonomy

This means respecting an individual’s right to make informed decisions about their own health.

As long as an individual understands a situation and its consequences, their decisions about their health must be respected. This includes if their choice is in conflict with what a medical professional would advise. 

Individuals also have the right to choose whether or not to share certain medical information with their employer, or anybody else. This means occupational health consultations are confidential by default. 

There are caveats to this, often related to where an individual’s choices put other people at risk. 

2. Beneficence

Practicing with the goal of improving or protecting an individual’s health.

Occupational health aims to promote health and reduce harm, both immediately and in the long term. A clinician’s advice will always be made with the best outcomes for health in mind.

This includes when recommending reasonable adjustments, when planning return to work or when advising on ill health retirement. Each recommendation is an individual decision based on optimising that individual’s health in their particular workplace context. 

3. Non-maleficence

This means avoiding harm or actions that may lead to harm. When occupational health clinicians make recommendations, this must be with consideration of the downside of any changes. This can lead to very nuanced decision making - when, for example, an employee may benefit from a change in work setting due to work-related stress, but that change itself could be a significant stressor. 

Weighing up the pros and cons of each course of action also means considering a psychosocial approach. Thinking 360 on someone’s situation, to include their physical health, mental health, and other factors that may impact their health-  is a fundamental aspect of good occupational health practice. 

4. Justice

This means ensuring fair medical practice. This could extend to triaging referrals fairly, ensuring the most urgent issues are addressed first within an occupational health service.

Justice can also mean considering the work/health interface at the wider team or service level, ensuring that nobody is unfairly placed at risk.

When ethical principles conflict: A case study

An individual attends an occupational health assessment. The clinician concludes that the person is not fit for their current role unless adjustments are implemented immediately. However, the employee wants to keep working without adjustments. The employee does not want their information shared with their employer. They say:

“I want to continue in the role as it is—even if it harms my health—I’m willing to take that risk.”

Which ethical principles are at play?

• Autonomy: As long as they are informed and understand the situation well, the individual has the right to make decisions about their own health and to control what is disclosed to others.

  
  

• Beneficence and non-maleficence: In applying these principles to the individual employee, the clinician must consider the risks of continued work without adjustments. These include potential harm to the individual and the consequences to the individual of sharing information about them without consent.

  
  

• Justice: The health and safety of others must be considered. Will the health of colleagues, clients, or service users be affected if the employee is unwell and remains in post without accommodations? Is there a beneficence and non-maleficence element to this dilemma that extends beyond the individual employee? 

  
  

Navigating ethical decisions in occupational health

When ethical principles are in tension, clinicians must weigh them carefully and aim to find the most ethically sound path forward. In this case, if the decision is made to override the individual's confidentiality to prevent harm, this would only be done:

• As a last resort

• With minimal necessary information shared

• And with clear justification and communication to the individual

This approach maintains the ethical integrity of the decision while respecting the individual's autonomy as much as possible.

Final thoughts

Occupational health professionals are not just making clinical judgments—they are applying medical ethics in real-world, often high-stakes situations, beyond a ‘doctor-patient’ relationship that is seen in treatment healthcare settings . By understanding the principles that guide these decisions, employers and employees alike can make better sense of the reasoning behind occupational health recommendations.