This chapter will explore the ethical principles of autonomy, beneficence, nonmaleficence, and justice in the context of humanistic surgical practice. To do so, three surgical cases will be described. For each case, an emphasis will be placed on the role that each principle plays in the clinical scenario and on areas in which the principles are in tension with each other. By describing these cases, we hope to demonstrate the value of using these principles to help answer ethical questions and guide thoughtful decision-making among patients and surgeons.