Cheat Sheet

Medical Ethics For Dummies

From Medical Ethics For Dummies by Jane Runzheimer, MD, Linda Johnson Larsen

Medical ethics is trying to do the right thing while achieving the best possible outcome for every patient. Principles and theories in medical ethics apply to just about every problem or situation. The interesting part of ethics is the discussion. How will you choose to balance the basic ethical principles so your patients receive the best care in any situation?

Basic Principles of Medical Ethics

There are four basic principles of medical ethics. Each addresses a value that arises in interactions between providers and patients. The principles address the issue of fairness, honesty, and respect for fellow human beings.

  • Autonomy: People have the right to control what happens to their bodies. This principle simply means that an informed, competent adult patient can refuse or accept treatments, drugs, and surgeries according to their wishes. People have the right to control what happens to their bodies because they are free and rational. And these decisions must be respected by everyone, even if those decisions aren’t in the best interest of the patient.

  • Beneficence: All healthcare providers must strive to improve their patient’s health, to do the most good for the patient in every situation. But what is good for one patient may not be good for another, so each situation should be considered individually. And other values that might conflict with beneficence may need to be considered.

  • Nonmaleficence: “First, do no harm” is the bedrock of medical ethics. In every situation, healthcare providers should avoid causing harm to their patients. You should also be aware of the doctrine of double effect, where a treatment intended for good unintentionally causes harm. This doctrine helps you make difficult decisions about whether actions with double effects can be undertaken.

  • Justice: The fourth principle demands that you should try to be as fair as possible when offering treatments to patients and allocating scarce medical resources. You should be able to justify your actions in every situation.

Helping Medical Patients Reach Informed Consent

Informed consent is an overarching point in medical ethics; yet reaching informed consent can be difficult. Providers need to be sure patients understand their conditions and the options for treatment before any procedure begins. You can do this by initiating a conversation, asking questions, and communicating clearly. Here are some additional tips:

  • Carefully describe the diagnosis and possible treatments.

  • Allow time for questions.

  • Use written forms describing procedures and go through them together.

  • Listen carefully to patient questions and statements.

  • Ask for feedback.

  • Avoid medical jargon when describing treatments.

  • Ask your patient to explain the situation to you in their own words.

  • Be aware of religious or cultural differences that may affect understanding.

  • Request an interpreter, if necessary.

  • Document the conversation in the patient’s chart.

Reviewing Ethics and Common Controversies in Medicine

Ethical principles are fine in theory, but putting them into practice is more difficult. Every situation is different, and ethical issues in medicine should be approached on a case-by-case basis. These are some common controversies, and how principles of medical ethics are applied to help solve them.

  • Abortion: Autonomy and nonmaleficence come into conflict in this issue. How much right does a woman have over her body, and how does that right balance with the rights of the fetus? Are there some cases when a therapeutic abortion is ethically mandated?

  • Physician-assisted suicide: If we respect autonomy, can we deny a patient’s request to die? Should doctors, traditionally committed to prolonging life, be involved in assisted suicide? How can providers honor the conflicting requirements of nonmaleficence, beneficence, and autonomy at the same time with this issue?

  • Conflicts of interest: For informed consent and patient autonomy to mean something, providers must tell patients what matters to their decision, including the potential for conflicts of interest, such as provider relationships with drug companies. Here, truthfulness is a primary ethical issue.

  • Relief of suffering at the end of life: To honor the principle of beneficence, providers should try to relieve suffering at to the best of their ability. However, some of the drugs that relieve suffering at the end of life can also hasten death. The double-effect rule helps you make decisions in these difficult situations.

  • Medical mistakes: Mistakes happen in all walks of life. But medical mistakes have the potential for hurting people and thereby violating the principle of nonmaleficence. Learning how to prevent mistakes, openly reporting mistakes, and learning from mistakes help you to respect the principles of nonmaleficence, justice, and beneficence.

  • Confidentiality: All four principles play a part in this issue. Can a patient’s medical information be kept confidential in the electronic age? When can confidentiality be breached? And who is allowed access to confidential information?

  • Healthcare rationing: Justice is the principle that applies in this issue. How can we fairly allocate limited healthcare resources to as many people as possible, without limiting resources to those who currently have them? Is it possible to reach a bare minimum of care for all?

  • Stem cell and genetic research: The frontiers of medicine exist in research. How can we balance beneficence and justice if embryos must be destroyed to perhaps find cures for devastating diseases? Should a patient know everything there is to know about his health and potential health risks? And can research be harmful to some in order to benefit many?

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