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Medical Ethics on the Physician Assistant Exam

There are some basic principles of medical ethics that you should be aware of and may see on the Physician Assistant Exam (PANCE). Medical ethics is a hot-button issue in medicine. Many books have been written about the subject. As a healthcare professional, you deal with ethical issues every day.

Practice ethical principles

Medical ethics come into play with every patient you see. Most of the time, what constitutes ethical behavior is pretty straightforward; occasionally, situations get messy, but these principles can help you do the right thing:

  • Doing no harm (nonmaleficence): The basic principle that all health professionals abide by is the principle of not doing harm to the patient. This is the principle of nonmaleficence (in Latin, Primum non nocere — “First, do no harm”), and it’s part of the Hippocratic Oath that all physicians take.

  • Benefiting the patient (beneficence): Although not performing certain actions or participating in certain activities that could harm the patient is important, you also want to do your best to benefit the patient. This is the principle of beneficence (in Latin, that’s Salus aegroti suprema lex).

  • Determination by the patient, not for the patient (autonomy): A key change in medicine is patient autonomy. Autonomy is the ability to decide and think for oneself. The patient has the right to refuse treatment or choose his or her treatment. The relationship between patient and medical professional should be one that promotes autonomy, not paternalism. In paternalism, one person tells someone else what to do.

    Promoting patient autonomy (or self-determination) means that as a medical professional, you need to explain options to a patient. The patient needs to be properly informed to make the best decisions possible about his or her care. With this knowledge, the patient can provide informed consent, which is vital for good patient care.

    For any procedure or proposed medical treatment, you tell the patient the benefits (the “why” of doing the procedure) in addition to the risks. For example, a cardiac catheterization is very beneficial in helping identify and treat symptomatic blockages of the coronary arteries. One potential risk is that the dye used may affect the kidneys, especially if risk factors such as diabetes and kidney disease are present.

    The patient must also be aware of other treatment options that may exist. He or she has the right to refuse any procedure or proposed medical treatment as well. The patient needs to know the consequences of not having a procedure done. As you can see, in addition to knowing your medical stuff, you need to be a good communicator.

Abide by patients’ rights

The patient is a partner in medical care and has rights that you must respect and abide by. These take the form of a “bill of rights” that healthcare professionals know and follow.

Where can you find a patient’s bill of rights? Walk into any hospital or healthcare center, and you can (and should) see a patient’s bill of rights, usually at the entrance. It’s also provided to each patient when he or she is admitted. The bill of rights should also be given to any patient who is establishing a new relationship with a doctor.

A patient’s bill of rights typically includes the following principles:

  • The patient should be fully informed about any procedure and/or proposed medical treatment as well as about his or her condition.

  • The patient should know that his or her medical information is confidential, a concept known as patient-provider privilege. Health professional–patient confidentiality is vital to good patient care.

  • The patient has the right to be treated by the provider he or she chooses. This includes consultations with medical specialists.

  • The patient has the right to refuse a medical treatment even if it’s highly recommended.

  • The patient has the right to be treated by the same provider and/or to change providers if he or she isn’t satisfied with the treatment.

For the PANCE, you should be familiar with the terms presented here. In many cases, you’ll be given different scenarios and asked to either identify the principle being described or pick the best answer for that situation.

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