Introduction to Medical Ethics

Definition of Ethics

• Ethical principles and rules define what is good and bad, right and wrong.

Definition of Medical Ethics

• Medical ethics is a system of moral principles that applies values and judgments to the practice of medicine.

Importance of Medical Ethics

• Understanding medical ethics can help a physician make ethical decisions during patient care.

Ethics vs Law

• Ethics are unenforceable norms and values that guide behavior.
• Laws are values written into enforceable standards of behavior.
• Laws are enforced by the justice system.

Autonomy vs Paternalism

• Autonomy: Patient’s right to decide and act for themselves, allowing them to accept or refuse examinations or treatments.
• Paternalism: Making decisions for a person without their knowledge or consent, believing it is in their best interest.

Importance of understanding the options

• Understanding medical ethics can help patients make informed decisions, ultimately fostering autonomy.

Mental Capacity

• An adult patient is considered to have mental capacity (able to make their own decisions).
• Those lacking mental capacity:
  • Unconscious patients.
  • Mentally retarded patients.

Honesty and Integrity

• Doctors are expected to be honest and act with integrity.
• Their actions should not be intended to deceive.

Confidentiality

• Patients have the right to confidentiality, meaning their information is kept secret and is not shared with a third party.
• Exceptions: Confidentiality is not absolute, especially if other people are at risk of serious harm.

Fairness & Equity

• People with equal needs should receive equal consideration.
• People should not be discriminated against in the provision of health services.
• Fairness and equity are related to using scarce resources effectively (distributive justice).
• Various perspectives on justice and equality exist:
  • Sufficiency view: Everyone has access to essential care (what is considered essential can vary).

Equity and Healthcare Resources

• Equity involves achieving the desired outcome for each individual patient and distributing resources accordingly.

Beneficence and Non-maleficence

• Beneficence: Maximizing benefit and minimizing harm.
• Non-maleficence: Avoiding harm.
• Medical interventions are justified when the anticipated benefits outweigh the harms.

Empathy

• Empathy involves understanding and concern for another person's problems.
• Physicians should identify:
  • Patient complaints.
  • Underlying causes.

Competence

• Doctors should be competent in their fields.
• How to ensure competence: Physicians undergo extensive training.
• Competence involves:
  • Appropriate knowledge.
  • Clinical reasoning.
  • Technical skills.

Principlism in Biomedical Ethics

• Principlism is a well-established approach in Biomedical Ethics that utilizes a set of values to guide medical professionals in cases of confusion or conflict.
• The four pillars of principlism:
  • Respect for autonomy: See prior explanation of autonomy.
  • Beneficence: Acting in the best interest of the patient (doing good and promoting well-being).
  • Non-maleficence: See prior explanation of non-maleficence.
  • Justice: Treating patients equitably and distributing benefits fairly.

How Principlism Applies to Decision-Making

• Principlism helps determine the right thing to do, considering both rules and consequences.

Therapeutic Relationship: Accepting or Refusing Patients

• Doctors have the freedom to accept or refuse to treat patients, except in emergencies.
• They may refuse to treat in the following situations:
  • Beyond their practicing hours.
  • Outside their specialty.
  • Illness beyond their competence and qualifications.
  • The doctor or a family member is ill.
  • The doctor has an important social function within their family.
  • The doctor is under the influence of alcohol.
  • The patient is malingering (pretending to be ill).
  • The patient defaults on payments.
  • The patient or their relatives are abusive or uncooperative.
  • The patient refuses to give consent.
  • The patient is an unaccompanied minor or female patient.
  • The doctor is engaged with an emergency or more serious case.

Formal Relationship: Third-Party Referrals

• When a third party refers a patient for medical examination, a formal relationship exists.
• This can occur in these situations:
  • Pre-employment.
  • Insurance policy.
  • Yearly medical checkups.
  • Rape or victim of crime cases (Medico-legal cases).
  • Certain psychiatric illnesses referred by court/police.