four pillars of medical ethics beneficence: act in the best interest of the patience non-maleficence: do no harm autonomy: respect the right of people to make decisions for themselves justice: seek fairness with what we do …on children autonomy is very adult centric… “substituted judgment is hard” altruistic surrogacy: act in the children’ best interest altruism: doesn’t require the consent / knowledge of others + doing something for someone else ethical equivalency Agreeing to withhold a treatment is equivalent to agreeing to stop it.