Transcript Medical Ethics

Medical Ethics
By Shauna O’Sullivan
Outline
• Background
• Definition of Medical Ethics
• Ethical Guideline
• Principles of Medical Ethics
Background
• Medical professionals increasingly find themselves
confronted with moral questions and ethical
dilemmas
• Need to reflect on the moral dimension  led to a
number of international ethical codes and guidelines
Background
• Documents present a set of basic principles for
medical ethics that are deemed universally valid by
interested bodies
• Many countries have established their own national
medical ruling bodies to govern ethical issues that
arise within their medical communities
Overview of Medical Ethics
• Medical profession has maintained simple medical
ethics standards for more than 4,000 years
– Hippocratic Oath, Prayer of Moses Maimonides, Bible, Holy
Koran, as well as cultures, traditions and social mortality
have shaped ethical standards
• Majority of these documents focus on “avoiding harm
to patients”
Definition of Medical Ethics
• A system of moral principles that apply values and
judgments to the practice of medicine
• “Ethics is the moral reasoning of actions”
– Morality refers to social norms that distinguish between
right and wrong in human conduct
• Ethics refers to a professional moral conduct
– Moral actions based on professional character and
ethical principles in each profession
Medical Ethics
• Medical professionals must confront ethical
dilemmas on a consistent basis
• Ethical dilemmas are not rare phenomena and thus
merit special attention
Medical Ethics
• Do the best for the patient and place the patient’s
interests before the interests of the physician
• Purpose is to protect and defend human dignity and
patient’s rights
• It is not about avoiding harm; rather, it is a set of
norms, values and principles
Ethical Guidelines
• International guidelines such as the Declaration of Geneva
(1948) proclaim that medical care must not violate any
universally applicable standards
• Help medical and professional professionals around the world
to:
– Recognize ethical dilemmas in medical and health care
– Provide general rules and principles to guide decision making
processes during these dilemmas
Ethical Guidelines
• Ethics is culturally defined
• Applied ethics involves cultures and traditions
– Relies on academia to inform the profession of ethical
theories and principles
• International guidelines acknowledge the need to
account for cultural values and traditions
Why is it important to adhere to
ethical standards in medical care?
• Promotes the aim of medical care: to alleviate
suffering
• Built on communication between medical providers
and patient’s or patient’s families
• Helps build support for medical care
Ethical Principles
• In the realm of health care, it is difficult to hold rules
or principles that are absolute
– Even thought they are not absolute they serve as powerful
action guides in clinical medicine
• For medical practice to be considered “ethical”
– It must respect all 4 of these principles: autonomy, nonmaleficence, beneficence and justice
Autonomy
• The right of patients to make decisions about their
medical care without their health care provider
trying to influence the decision
• Patient autonomy does allow for health care
providers to educate the patient but does not allow
the health care provider to make the decision for the
patient
Autonomy
• Respect for autonomy is one of the fundamental
guidelines of medical ethics
• Autonomy in medicine is not simply allowing patients
to make their own decisions
• Physicians have an obligation to create the
conditions necessary for autonomous choice in
others
Autonomy
• For a physician, respect for autonomy includes
respecting an individual’s right to self-determination
as well as creating the conditions necessary for
autonomous choice
• This principle is the basis of “informed consent”
Informed Consent
• Informed consent is more than simply getting a
patient to sign a written consent form
• Process of communication between a patient and
physician that results in the patient’s agreement to
undergo a specific medical intervention
Informed Consent
• Communication process must involve:
– Patient's diagnosis, if known;
– Nature and purpose of a proposed treatment
– Risks and benefits of a proposed treatment
– Alternatives to the treatment
– Risks and benefits of the alternative treatment
– Risks and benefits of not receiving treatment
Autonomy
• Includes confidentiality, seeking consent for medical
treatment and procedures, disclosing information about
their medical condition to patients, and maintaining
privacy
• Illustrative case: Jehovah’s Witnesses have a belief that it
is wrong to accept a blood transfusion
– What happens if a blood transfusion is needed to save a
person’s life?
Non-maleficence
• “Do no harm ”
• Physicians must refrain from providing ineffective
treatments or acting with malice toward patients
• This principle is difficult as many beneficial
therapies also have serious risks
– The pertinent ethical issue is whether the benefits
outweigh the burdens
Non-maleficence
• Considered negligence if one imposes a
careless or unreasonable risk of harm to
another
• Providing a proper standard of care
– Avoids or minimizes the risk of harm is supported
by moral convictions but laws of society as well
Non-maleficence
• This principle affirms the need for medical
competence
– It is clear that medical mistakes occur
– This principle articulates a fundamental
commitment on the part of medical professionals
to protect their patients from harm
Non-maleficence
• Illustrative case: How to best treat a pregnant
women with newly diagnosed uterine cancer
– A single action may have 2 effects, one that is considered
good and the other bad (Principle of double effect)
– What do you think about this case? What is right and
what is wrong?
Beneficence
• Duty of the health care provider to be of benefit to the patient
– Take positive steps to prevent and to remove harm from the
patient
• These duties are viewed as self-evident and viewed as the
proper goals of medicine
• These goals are applied to both the patient, and to the good of
society as a whole
– Vaccinations for disease prevention example
Beneficence
• Illustrative case: One clear example exists in health care where
principle of beneficence is given priority over the principle of
respect of autonomy
• Example is in the Emergency Room: Patient is incapacitated by
the grave nature of accident or illness
– We presume that the reasonable person would want to be
treated aggressively and we rush to provide beneficent
intervention
Autonomy vs. Beneficence
• Often the most common and difficult ethical issues to
navigate arise when the patient’s autonomous decision
conflicts with the physician’s beneficent duty
– Should a patient who has had heart bypass surgery
continue to smoke?
– What would you do if a patient with pneumonia refuses
antibiotics?
Justice
• Justice in health care is usually defined as a form of
fairness, or as Aristotle once said, "giving to each
that which is his due“
• Deals with issues of treating patients equally
• Physicians should treat similarly situated patients
similarly and allocate resources justly
Justice
• If you had ten patients and only enough medicine to
save five, who would you give the medication to
first?
Summary
• Medical professionals increasingly find themselves
confronted with moral questions and ethical dilemmas
• Ethics refers to a professional moral conduct
• For medical practice to be considered “ethical”
– It must respect all 4 of these principles: autonomy,
non- maleficence, beneficence and justice
Any Questions?
References
• www.ama-assn.org (AMA code of ethics)
• http://depts.washington.edu (Ethics in Medicine)
• Gillon R. Medical Ethics: four principles plus
attention to scope. BMJ. 1994 Jul 16;
309(6948):184-8.