Four Basic Medical Ethics Principles, Study notes of Medical ethics

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Monograph 3

Basic Medical Ethics Principles

Brian H. Childs, Ph.D. Professor of Bioethics and Professionalism The foundation for what we call basic medical ethics principles is first and foremost the concept that the practice of medicine is in and of itself is an ethical profession. The physician’s covenant with society confers many privileges upon the physician and the physician in return promises to hold the health interests of the patient as the reason for her or his practice. It is always about the patient. It has been said that medicine saved the life of ethics. What this means is that the rapid advance of medical technology and specialization and costs has demanded that ethics be more than the philosophical musing about abstractions. It means that physicians and patients and public policies must make very practical and immediate moral decisions about care including even redefining death. All of this is complicated by the expansion of who or what may be involved in medical decision making. We have moved from the notion of a pure binary relationship between physician and patient to a relationship surrounded by a kind of Greek Chorus of insurance companies, managed care initiatives, government regulations, and claims of health care outside of allopathic medicine such as naturopathy, homeopathy, and others. Take an example: the ubiquitous ventilator found in any ICU. Though the iron lung was first developed in 1928 it wasn’t until the 1950’s that the ventilator as we know it came into common use. Think about this. It changed the rules of the landscape entirely. It forced us to ask questions that previously were considered abstract: what is the meaning of life? What is death? What is it that makes a person a person? What are the financial costs and who is responsible for them? How do we decide who merits the intervention if the need is greater than the availability of the resource? You get the idea. Always remember: It is about the patient!

1. There are four general principles largely recognized as useful in recognizing ethical conundrums and opportunities

a. Respect for personal autonomy i. Persons have a right to live out their life plan without interference and the physician aids and abets patient autonomy by

1. Telling the truth
2. Respects privacy
3. Protects confidential information
4. Obtains consent for interventions
5. When asked, helps with important decisions
6. If the patient lacks capacity to communicate finds someone who can speak for the patient (surrogate, living will/advance directive/ healthcare power of attorney) b. Beneficence i. The physician’s virtue of compassion and being composed to act for the benefit of the patient. A physician may abet beneficence by
7. Defending and ensuring the rights of others
8. Prevent harm from occurring to others
9. Prevent or remove conditions that could harm others
10. Support those with disabilities
11. Rescue those in danger c. Nonmaleficence i. Often claimed to be the center of the Hippocratic tradition: “First, do no harm.” A physician upholds this principle by
12. Not inflicting harm or evil
13. Preventing the infliction of harm or evil
14. Removing harm or evil
15. Promoting good d. Justice i. Is usually associated with the fair and equal distribution of essential services (health care) in the face of limited accessibility. As mentioned in the introduction of this outline this is a problematical issue for physicians and patients in that it is arbitrated, usually, through third parties: government policy, insurance companies, and financial costs. The application of justice in

healthcare is highly controversial. This is a topic that will be discussed in every case conference we have and, in our classroom. Several principles of justice may include

1. To each the means for the realization of core dimensions of well-being
2. To each the means for the exercise those things that are essential for the flourishing of life
3. To each to maximize social welfare
4. To each a fair distribution of goods deemed necessary for the above three principles ii. There is one area in American healthcare that seems to comply well with these principles of justice: the recovery and distribution of organs and tissue for transplantation. How these principles are used in identifying and solving ethical conundrums in medical practice is the topic of my paper “A Method for Ethical Decision Making” found on this site and in the “Ethics and Professionalism” site in the on-line Medical Library site. Resource: Tom L. Beauchamp and James F. Childress. Principles of Biomedical Ethics (7th^ ed.) Rosamond Rhodes, The Trusted Doctor: Medical Ethics and Professionalism