Four Basic Medical Ethics Principles, Study notes of Medical ethics

Download Four Basic Medical Ethics Principles and more Study notes Medical ethics in PDF only on Docsity! 1 Monograph 3 Basic Medical Ethics Principles Brian H. Childs, Ph.D. Professor of Bioethics and Professionalism The foundation for what we call basic medical ethics principles is first and foremost the concept that the practice of medicine is in and of itself is an ethical profession. The physician’s covenant with society confers many privileges upon the physician and the physician in return promises to hold the health interests of the patient as the reason for her or his practice. It is always about the patient. It has been said that medicine saved the life of ethics. What this means is that the rapid advance of medical technology and specialization and costs has demanded that ethics be more than the philosophical musing about abstractions. It means that physicians and patients and public policies must make very practical and immediate moral decisions about care including even redefining death. All of this is complicated by the expansion of who or what may be involved in medical decision making. We have moved from the notion of a pure binary relationship between physician and patient to a relationship surrounded by a kind of Greek Chorus of insurance companies, managed care initiatives, government regulations, and claims of health care outside of allopathic medicine such as naturopathy, homeopathy, and others . Take an example: the ubiquitous ventilator found in any ICU. Though the iron lung was first developed in 1928 it wasn’t until the 1950’s that the ventilator as we know it came into common use. Think about this. It changed the rules of the landscape entirely. It forced us to ask questions that previously were considered abstract: what is the meaning of life? What is death? What is it that makes a person a person? What are the financial costs and who is responsible for them? How do we decide who merits the intervention if the need is greater than the availability of the resource? You get the idea. Always remember: It is about the patient! 1. There are four general principles largely recognized as useful in recognizing ethical conundrums and opportunities 2 a. Respect for personal autonomy i. Persons have a right to live out their life plan without interference and the physician aids and abets patient autonomy by 1. Telling the truth 2. Respects privacy 3. Protects confidential information 4. Obtains consent for interventions 5. When asked, helps with important decisions 6. If the patient lacks capacity to communicate finds someone who can speak for the patient (surrogate, living will/advance directive/ healthcare power of attorney) b. Beneficence i. The physician’s virtue of compassion and being composed to act for the benefit of the patient. A physician may abet beneficence by 1. Defending and ensuring the rights of others 2. Prevent harm from occurring to others 3. Prevent or remove conditions that could harm others 4. Support those with disabilities 5. Rescue those in danger c. Nonmaleficence i. Often claimed to be the center of the Hippocratic tradition: “First, do no harm.” A physician upholds this principle by 1. Not inflicting harm or evil 2. Preventing the infliction of harm or evil 3. Removing harm or evil 4. Promoting good d. Justice i. Is usually associated with the fair and equal distribution of essential services (health care) in the face of limited accessibility. As mentioned in the introduction of this outline this is a problematical issue for physicians and patients in that it is arbitrated, usually, through third parties: government policy, insurance companies, and financial costs. The application of justice in