Ethics is the branch of philosophy dealing with the values relating human conduct with respect of rightness and wrongness of certain actions. Medical ethics is the system of moral principles that apply values to the practice of clinical medicine and scientific research.
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Principles of medical ethics
Respect for autonomy
- Beneficence
- Non-maleficence
- Justice
- Consequentialism
- Deontology
- Virtue ethics
- Casuistry
- Narrative ethics
The first four principles of medical ethics are called the core principles. Beauchamp and Childress (American bioethicists) coined these four core principles approach for analysis of ethical dilemmas in Medicine.
1. Respect for autonomy
It addresses the concept of independence and allows an individual the freedom of choice and action. It is an ability if an individual to make rational uninfluenced decision. Autonomy, in simple words, is the right of the patients to make decision about their medical care without the influence of health care provides influence. Patient autonomy does allow to educate the patients but does not allow the healthcare providers to make decision for patient.
Examples of patient’s autonomy:
- Right to accept or not accept the medical care.
- Choosing the doctor whom the patient is comfortable with.
- To make end life decisions.
The patient’s autonomy is challenged in certain conditions like when the patients are legally deemed unable to make rational decisions to themselves, when the patient is clinically determined to be unable to make decisions or patient is threat to self or others.
Psychiatrists and psychologists may be involved to support decision making for the person with psychiatric conditions and may lack the capacity to make decisions. Just because the patient lacks capacity to make a particular decision does not mean that doctor should override their wishes.
2. Beneficence:
The patient must be benefitted. A doctor must act in patient’s best interest when they lack the autonomy to make decision about their health. At the individual level, it is used to promote equality among patients from all walks of life, irrespective of culture, religion, or nationality.
Examples of beneficence:
- Resuscitating drawing victim (suicidal case)
- Providing vaccination
- Mandatory Treating TB
- Giving nasogastric feed to the patient of obsessive compulsive disorders receiving cognitive behavioral therapy and with anorexia nervosa.
3. Non maleficence
It states that it is more important not to harm your patient than to benefit them. It reflects the idea of both not inflicting intentional harm and not engaging in actions that risk harming others. It is not only more important to harm patient but to know how the treatment will harm the patient. But all the treatment carry some of the herm, in those situations risks of treatments are justified to patient as risk of not treating will also harm. It is not absolute in practice and may conflict against the beneficence.
Examples of non Non maleficence
- Removing organ or limb that is causing disease.
- Providing high dose analgesics even though it may shorten the life
- Performing unrequested abortion to save the mother’s life.
- Principle of double effect: It says unintended medical consequences are acceptable if the intended consequences are legitimate and the harm is less than benefit.
4. Justice
It means to treat person fairly and equitable and how health care is apportioned when health and financial resources may be limited. It is proper allocation of resources in manner that is fair and justice.
Examples of Justice
- Triage: It is the process of determining the priority of patient treatments by severity of their complications.
- Doctor may spend more time with very ill patient than patient with less ill patient.
- First person through emergency door is not necessarily attend to first.
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References:
- Simpsons’s Forensic Medicine; Jason Payne-James, Richard Jones, Steven B Karch, John Manlove.
- Carolyn A. Bernstein, MD, FAHS; Take control of your health care (exert your patient autonomy) Harvard Health Blog; 2018-05-07.
- Essentials of Forensic Medicine and Toxicology; KN Reddy, OP Murty.
- Principles of Forensic Medicine; A. Nandi.
- Death and Deduction: A reasoned Approach to Forensic Pathology; AJ Chapman.
- Review of Forensic Medicine and Toxicology: Gautam Biswas.
- (100 Cases) Bradbury, Penelope Johnston, Carolyn; 100 cases in clinical ethics and law-CRC Press (2016).
- Medical Ethics Explained: Beneficence; The medical portal blogs.
- Beauchamp, Tom, The Principle of Beneficence in Applied Ethics; The Stanford Encyclopedia of Philosophy, editor Edward N. Zalta, Spring 2019 edition, Published by Metaphysics Research Lab, Stanford University.
- Beneficence Nursing and Ethics; Husson University online blogs.
- Medical Ethics: What is it? Why is it important?; Dya Eldin M. Elsayed1, Rabaa Elamin M. Ahmed.
- Ethics; Dr.Waseem Ahmed Abujamea, MD ED CONSULTUNT,SBEM,AbEM PROGRAM DIRECTOR KSMC DEPUTY CHAIRMAN EMERGENY DEPARTMENT KSMC.
