Medical ethics

Refers to a system of moral principles that apply values and judgments to the practice of medicine.

Encompasses clinical settings as well as work on its history, philosophy, and sociology.

Well-known medical ethics cases include:

Four basic moral principles:

Patient autonomy-the patient has the right to refuse or choose their treatment.

Beneficence – a practitioner should act in the best interest of the patient.

Non-maleficence – first, do no harm-primum non nocere.

Justice – concerns the distribution of scarce health resources-fairness and equality

Other significant values include:

Respect for persons-the patient has a right to be treated with dignity.

Truthfulness and honesty – the concept of informed consent.

Conflicting moral values may lead to ethical dilemma or crises.

Sometimes, no good solution to a dilemma in medical ethics exists.

Occasionally the values of the medical community conflict with the values of the individual patient, family, or larger non-medical community.

Conflicts can also arise between health care providers, or among family members.

The principle of autonomy views the rights of an individual to self-determination, and respect for individuals’ ability to make informed decisions about personal matters.

Respect for autonomy is the basis for informed consent and advance directives.

Autonomy is a general indicator of health.

Autonomy is an indicator for both personal well-being, and for the well-being of the profession.

Ethical consideration tries to find a beneficial balance between the activities of the individual and its effects on a collective.

Patients with a psychiatric condition may lack capacity to make end-of-life decisions, and should be treated according to their best interests by involving people who know the person best to what decisions the person would have made had they not lost capacity.

Beneficence promotes the well being of others, and it is considered by some as the core of medical ethics.

Primum non nocere, the concept of non-maleficence is embodied by the phrase, “first, do no harm”, and is a primary consideration that is balanced against beneficence.

Double effect refers to the combined effect of beneficence and non-maleficence: e.g. the use of morphine or other analgesic in the dying patient.

Medical doctors have an ethical duty to protect the human rights and human dignity of the patient.

Most codes of medical ethics now require respect for the human rights of the patient.

No organ or tissue removal may be carried out on a person who does not have the capacity to consent.

Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected.

Autonomy can conflict with beneficence when patients disagree with recommendations that healthcare professionals believe are in the patient’s best interest.

Associated with the concept that a person must be fully informed about and understand the potential benefits and risks of their choice of treatment.

An uninformed person may mistakenly making a choice not reflective of his or her values or wishes. . Patients can make their own medical decisions, or can delegate decision-making authority to another party.

Informed consent is closely related to the values of autonomy and truth telling.

Confidentiality, known as patient-physician privilege is applied to conversations between doctors and patients.

Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.

Exceptions to the rules include: requiring physicians to report gunshot wounds, impaired drivers, termination of a pregnancy in an underage patient, without the knowledge of the patient’s parents, and cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse,

Traditionally, medical ethics has viewed confidentiality as a relatively non-negotiable tenet of medical practice.

Many ethical conflicts in medical ethics are traceable to a lack of communication.

Hospital accreditation requires that ethical considerations are taken into account, for example with respect to physician integrity, conflict of interest, research ethics and organ transplantation ethics.

The Declaration of Helsinki is regarded as authoritative in human research ethics.

Often, a hospital ethics committee must convene to decide a complex matter.

Hospital ethics committees are composed primarily of healthcare professionals, but may also include lay people, and clergy.

Culture differences can create difficult medical ethics problems.

Physicians should not allow a conflict of interest to influence medical judgment.

Studies show that doctors can be influenced by drug company inducements, including gifts and food.

Doctors who treat family must be vigilant not to create conflicts of interest or treat inappropriately.

Sexual consent may conflict with the fiduciary responsibility of the physician, and those who enter into sexual relationships with patients face the threats of losing their medical license and prosecution.

Sexual relationships between physicians and patients’ relatives may also be prohibited.

Advance directives include living wills and durable powers of attorney for health care: In many cases, the expressed wishes of the patient are documented in these directives, and this provides a framework to guide family members and health care professionals in the decision-making process when the patient is incapacitated.

Baby Doe Law establishes state protection for a disabled child’s right to life, ensuring that this right is protected even over the wishes of parents or guardians in cases where they want to withhold treatment.

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