Part I
Medical Ethics, or Doing the Right Thing
In this part . . .
Medical ethics, also called bioethics, is the underpinning of any medical practice. To understand medical ethics, you need to look at the historical context and guideposts that have been developed over the years. “Doing the right thing” sounds simple, but can be difficult in practice. We define the four main principles of medical ethics, take a look at the basics of running an ethical practice, examine the doctor-patient relationship, and discover what to do when mistakes are made.
Chapter 1
What Are Medical Ethics?
In This Chapter
Defining medical ethics
Looking at common controversies
Moving medicine forward in research
Do the right thing. It sounds so easy, but it isn’t. Every time a story is written about any medical issue, whether it’s abortion, end-of-life care, or multiple births, everyone has an opinion about what’s right and what’s wrong. We’re bombarded with two or more opposing viewpoints, and each one sound reasonable. But which one is right?
And that’s medical ethics in a nutshell. What’s the right thing to do? How do we structure clinics, hospitals, and government so the most people benefit and patients are treated with respect and compassion? What should you, as the provider, do in certain situations?
There are guidelines and principles in place to help us make decisions, but sometimes those come into direct conflict with each other. When that happens, we need to use logical reasoning skills, ethical theories, and some tools of philosophy to balance and weigh our options. Even after all of that is done, there are still questions. Medical ethics gets into the gray areas of life. As you look at these issues in more depth, you realize there aren’t many that are truly black and white.
In this chapter, we define medical ethics, look at the differences between ethical and legal behaviors, and explain the difference between patient rights and provider responsibilities. We need to understand the guidelines and guideposts to follow while treating patients in all stages of life. We look at some of the common and hot-button controversies and take a peek at the ethics of medical research, which is on the forefront of medicine.
Defining Medical Ethics
Healthcare providers have always been respected and even revered. As societies were formed, ethical principles were developed by physicians and scholars from all walks of life. From Hippocrates to Muhammad ibn Zakariya ar-Razi to Thomas Aquinas, physicians and theologians have crafted guidelines to aid providers in their quest to help patients.
As a result, the American Medical Association has written a Code of Medical Ethics that covers most situations healthcare providers face in their careers. The Code is made up of guidelines and opinions written by ethical scholars and physicians. Whenever you have a question about an ethical issue, the Code will provide a good basis for your decisions. (See Chapter 2 for more on the AMA Code.)
In this section, we define the four principles of medical ethics. We also look at the differences between ethics and the law, and how you should reconcile patient care with ethical standards. One of the most important facts in medical ethics is that they are not static. Medical ethics have changed over the years and will continue to evolve as medicine advances.
What are ethics?
Ethics and morality mean the same thing to many people, and they are similar. Morals are used to describe personal character, whereas ethics defines behavior in different situations. Morality refers to personal character, beliefs, and behavior; ethics is about the reflection on morality and deciding how to act as a person or a professional. An ethical person and a moral person are usually one and the same. We use medical ethics to refer to those guidelines and behaviors that we expect a medical professional with moral integrity to exhibit.
Ethics has developed over the centuries as a code of conduct, especially for professionals. Healthcare providers have so much knowledge about the human body, so much potential power over patients, and the ability to change and save lives. Because of these factors, the ethical bar is set very high, and providers have moral obligations to their patients.
The field of medical ethics is really about reflection on how to behave as a medical professional as well as the morality of particular medical interventions. Medical ethics are simply some key ethical principles applied to the practice of medicine. These principles are the bedrock of good clinical practice, and they are autonomy, nonmaleficence, beneficence, and justice. But they often come in conflict with each other as they are applied to a case. By using these principles in each individual case, it can be easier to make difficult decisions with your patients as you guide them through their care.
The four principles of medical ethics
The four major principles of medical ethics are
Autonomy: This principle is focused on the patient’s independence or liberty. A competent adult has the right to make decisions about what happens to his body. The person must be capable of rational thought and not be manipulated or coerced into any decision. An adult can refuse medical care or treatment or accept treatment when his provider suggests it. That person then lives with the consequences of his decision.
Beneficence: This principle states that a physician must act in the best interest of the patient. Providers are required to promote their patient’s health and well-being. Most doctors agree that healing is the main purpose of modern medicine. Beneficence means providers must help their patients.
Nonmaleficence: First, do no harm. Physicians must not harm a patient through carelessness, malice, vengeance, or dislike, or even through treatments intended to help the patient. This principle is balanced with beneficence in that any risks of a treatment or procedure to a patient must be outweighed by benefit. Some treatments always carry a risk of harm. But when the treatment is very risky, the benefit must be great, or the risk of not performing the procedure must be great.
Double effect is an offshoot of nonmaleficence. A treatment that is normally used to help someone may have an unintended negative effect. For instance, a vaccine used to prevent disease can, in rare cases, actually cause the infection it is intended to prevent. This principle provides specific guidance when determining when unintended effects are justified and when they are not.
Justice: Justice refers to fairness with respect to the distribution of medical resources. This principle draws upon ethics, the law, and public policy. Who should receive scarce medical resources, and how should we distribute them in order to realize the best outcomes? Mak...
