Medical ethics notes
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About This Presentation
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Slide Content
A 12th-century Byzantine manuscript of the Hippocratic Oath
AMA Code of Medical Ethics
Medical ethics is an applied branch of ethics which analyzes the practice of
clinical medicine and related scientific research. Medical ethics is based on a
set of values that professionals can refer to in the case of any confusion or
conflict. These values include the respect for autonomy, non-
maleficence, beneficence, and justice.
[1]
Such tenets may allow doctors, care
providers, and families to create a treatment plan and work towards the same
common goal.
[2]
It is important to note that these four values are not ranked in
order of importance or relevance and that they all encompass values pertaining
to medical ethics.
[3]
However, a conflict may arise leading to the need for
hierarchy in an ethical system, such that some moral elements overrule others
with the purpose of applying the best moral judgement to a difficult medical
situation.
[4]
Medical ethics is particularly relevant in decisions
regarding involuntary treatment and involuntary commitment.
There are several codes of conduct. The Hippocratic Oath discusses basic
principles for medical professionals.
[4]
This document dates back to the fifth
century BCE.
[5]
Both The Declaration of Helsinki (1964) and The Nuremberg
AMA Code of Medical Ethics
Medical ethics is an applied branch of ethics which analyzes the practice of
clinical medicine and related scientific research. Medical ethics is based on a
set of values that professionals can refer to in the case of any confusion or
conflict. These values include the respect for autonomy, non-
maleficence, beneficence, and justice.
[1]
Such tenets may allow doctors, care
providers, and families to create a treatment plan and work towards the same
common goal.
[2]
It is important to note that these four values are not ranked in
order of importance or relevance and that they all encompass values pertaining
to medical ethics.
[3]
However, a conflict may arise leading to the need for
hierarchy in an ethical system, such that some moral elements overrule others
with the purpose of applying the best moral judgement to a difficult medical
situation.
[4]
Medical ethics is particularly relevant in decisions
regarding involuntary treatment and involuntary commitment.
There are several codes of conduct. The Hippocratic Oath discusses basic
principles for medical professionals.
[4]
This document dates back to the fifth
century BCE.
[5]
Both The Declaration of Helsinki (1964) and The Nuremberg
Code (1947) are two well-known and well respected documents contributing to
medical ethics. Other important markings in the history of medical ethics
include Roe v. Wade
[why?]
in 1973 and the development of hemodialysis
[why?]
in
the 1960s. More recently, new techniques for gene editing aiming at treating,
preventing and curing diseases utilizing gene editing, are raising important
moral questions about their applications in medicine and treatments as well as
societal impacts on future generations,
[6][7]
yet remain controversial due to their
association with eugenics.
[8]
As this field continues to develop and change throughout history, the focus
remains on fair, balanced, and moral thinking across all cultural and religious
backgrounds around the world.
[9][10]
The field of medical ethics encompasses
both practical application in clinical setting s and scholarly work
in philosophy, history, and sociology.
Medical ethics encompasses beneficence, autonomy, and justice as they relate
to conflicts such as euthanasia, patient confidentiality, informed consent, and
conflicts of interest in healthcare.
[11][12][13][14]
In addition, medical ethics and
culture are interconnected as different cultures implement ethical values
differently, sometimes placing more emphasis on family values and
downplaying the importance of autonomy. This leads to an increasing need
for culturally sensitive physicians and ethical committees in hospitals and
other healthcare settings.
[9][10][15]
Contents
1History
2Values
o 2.1Autonomy
o 2.2Beneficence
o 2.3Non-maleficence
2.3.1Double effect
o 2.4Respect for human rights
o 2.5Solidarity
o 2.6Acceptance of ambiguity in medicine
3Conflicts
o 3.1Between autonomy and beneficence/non -
maleficence
o 3.2Euthanasia
4Informed consent
5Confidentiality
o 5.1Privacy and the Internet
6Control and resolution
o 6.1Guidelines
o 6.2Ethics committees
7Cultural concerns
medical ethics. Other important markings in the history of medical ethics
include Roe v. Wade
[why?]
in 1973 and the development of hemodialysis
[why?]
in
the 1960s. More recently, new techniques for gene editing aiming at treating,
preventing and curing diseases utilizing gene editing, are raising important
moral questions about their applications in medicine and treatments as well as
societal impacts on future generations,
[6][7]
yet remain controversial due to their
association with eugenics.
[8]
As this field continues to develop and change throughout history, the focus
remains on fair, balanced, and moral thinking across all cultural and religious
backgrounds around the world.
[9][10]
The field of medical ethics encompasses
both practical application in clinical setting s and scholarly work
in philosophy, history, and sociology.
Medical ethics encompasses beneficence, autonomy, and justice as they relate
to conflicts such as euthanasia, patient confidentiality, informed consent, and
conflicts of interest in healthcare.
[11][12][13][14]
In addition, medical ethics and
culture are interconnected as different cultures implement ethical values
differently, sometimes placing more emphasis on family values and
downplaying the importance of autonomy. This leads to an increasing need
for culturally sensitive physicians and ethical committees in hospitals and
other healthcare settings.
[9][10][15]
Contents
1History
2Values
o 2.1Autonomy
o 2.2Beneficence
o 2.3Non-maleficence
2.3.1Double effect
o 2.4Respect for human rights
o 2.5Solidarity
o 2.6Acceptance of ambiguity in medicine
3Conflicts
o 3.1Between autonomy and beneficence/non -
maleficence
o 3.2Euthanasia
4Informed consent
5Confidentiality
o 5.1Privacy and the Internet
6Control and resolution
o 6.1Guidelines
o 6.2Ethics committees
7Cultural concerns
o 7.1Culture and language
o 7.2Medical humanitarianism
o 7.3Healthcare reform and lifestyle
o 7.4Other cultures and healthcare
7.4.1Buddhist medicine
7.4.2Chinese medicine
7.4.3Islamic culture and medicine
8Conflicts of interest
o 8.1Referral
o 8.2Vendor relationships
o 8.3Treatment of family members
o 8.4Sexual relationships
9Futility
10See also
o 10.1Reproductive medicine
o 10.2Medical research
11References
12Sources
13External links
History
See also: List of medical ethics cases
The term medical ethics first dates back to 1803, when English author and
physician Thomas Percival published a document describing the requirements
and expectations of medical professionals within medical facilities. The Code of
Ethics was then adapted in 1847, relying heavily on Percival's words.
[16]
Over
the years in 1903, 1912, and 1947, revisions have been made to the original
document.
[16]
The practice of Medical Ethics is widely accepted and practiced
throughout the world.
[3]
Historically, Western medical ethics may be traced to guidelines on the duty of
physicians in antiquity, such as the Hippocratic Oath, and
early Christian teachings. The first code of medical ethics, Formula Comitis
Archiatrorum, was published in the 5th century, during the reign of
the Ostrogothic king Theodoric the Great. In the medieval and early modern
period, the field is indebted to Islamic scholarship such as Ishaq ibn Ali al-
Ruhawi (who wrote the Conduct of a Physician, the first book dedicated to
medical ethics), Avicenna's Canon of Medicine and Muhammad ibn Zakariya
ar-Razi (known as Rhazes in the West), Jewish thinkers such
as Maimonides, Roman Catholic scholastic thinkers such as Thomas Aquinas,
and the case-oriented analysis (casuistry) of Catholic moral theology. These
intellectual traditions continue in Catholic, Islamic and Jewish medical ethics.
By the 18th and 19th centuries, medical ethics emerged as a more self -
conscious discourse. In England, Thomas Percival, a physician and author,
o 7.2Medical humanitarianism
o 7.3Healthcare reform and lifestyle
o 7.4Other cultures and healthcare
7.4.1Buddhist medicine
7.4.2Chinese medicine
7.4.3Islamic culture and medicine
8Conflicts of interest
o 8.1Referral
o 8.2Vendor relationships
o 8.3Treatment of family members
o 8.4Sexual relationships
9Futility
10See also
o 10.1Reproductive medicine
o 10.2Medical research
11References
12Sources
13External links
History
See also: List of medical ethics cases
The term medical ethics first dates back to 1803, when English author and
physician Thomas Percival published a document describing the requirements
and expectations of medical professionals within medical facilities. The Code of
Ethics was then adapted in 1847, relying heavily on Percival's words.
[16]
Over
the years in 1903, 1912, and 1947, revisions have been made to the original
document.
[16]
The practice of Medical Ethics is widely accepted and practiced
throughout the world.
[3]
Historically, Western medical ethics may be traced to guidelines on the duty of
physicians in antiquity, such as the Hippocratic Oath, and
early Christian teachings. The first code of medical ethics, Formula Comitis
Archiatrorum, was published in the 5th century, during the reign of
the Ostrogothic king Theodoric the Great. In the medieval and early modern
period, the field is indebted to Islamic scholarship such as Ishaq ibn Ali al-
Ruhawi (who wrote the Conduct of a Physician, the first book dedicated to
medical ethics), Avicenna's Canon of Medicine and Muhammad ibn Zakariya
ar-Razi (known as Rhazes in the West), Jewish thinkers such
as Maimonides, Roman Catholic scholastic thinkers such as Thomas Aquinas,
and the case-oriented analysis (casuistry) of Catholic moral theology. These
intellectual traditions continue in Catholic, Islamic and Jewish medical ethics.
By the 18th and 19th centuries, medical ethics emerged as a more self -
conscious discourse. In England, Thomas Percival, a physician and author,
crafted the first modern code of medical ethics. He drew up a pamphlet with
the code in 1794 and wrote an expanded version in 1803, in which he coined
the expressions "medical ethics" and "medical jurisprudence".
[17]
However,
there are some who see Percival's guidelines that relate to physician
consultations as being excessively protective of the home physician's
reputation. Jeffrey Berlant is one such critic who considers Percival's codes of
physician consultations as being an early example of the anti -competitive,
"guild"-like nature of the physician community.
[18][19]
In addition, since the mid
19th century up to the 20th century, physician-patient relationships that once
were more familiar became less prominent and less intimate, sometimes
leading to malpractice, which resulted in less public trust and a shift in
decision making power from the paternalistic physician model to today's
emphasis on patient autonomy and self-determination.
[20]
In 1815, the Apothecaries Act was passed by the Parliament of the United
Kingdom. It introduced compulsory apprenticeship and formal qualifications
for the apothecaries of the day under the license of the Society of Apothecaries.
This was the beginning of regulation of the medical profession in the UK.
In 1847, the American Medical Association adopted its first code of ethics, with
this being based in large part upon Percival's work.
[21]
While the secularized
field borrowed largely from Catholic medical ethics, in the 20th century a
distinctively liberal Protestant approach was articulated by thinkers such
as Joseph Fletcher. In the 1960s and 1970s, building upon liberal
theory and procedural justice, much of the discourse of medical ethics went
through a dramatic shift and largely reconfigured itself into bioethics.
[22]
Well-known medical ethics cases include:
Albert Kligman's dermatology experiments
Deep sleep therapy
Doctors' Trial
Greenberg v. Miami Children's Hospital Research
Institute
Henrietta Lacks
Chester M. Southam's Cancer Injection Study
Human radiation experiments
Jesse Gelsinger
Moore v. Regents of the University of California
Surgical removal of body parts to try to improve
mental health
Medical Experimentation on Black Americans
Milgram experiment
Radioactive iodine experiments
The Monster Study
Plutonium injections
the code in 1794 and wrote an expanded version in 1803, in which he coined
the expressions "medical ethics" and "medical jurisprudence".
[17]
However,
there are some who see Percival's guidelines that relate to physician
consultations as being excessively protective of the home physician's
reputation. Jeffrey Berlant is one such critic who considers Percival's codes of
physician consultations as being an early example of the anti -competitive,
"guild"-like nature of the physician community.
[18][19]
In addition, since the mid
19th century up to the 20th century, physician-patient relationships that once
were more familiar became less prominent and less intimate, sometimes
leading to malpractice, which resulted in less public trust and a shift in
decision making power from the paternalistic physician model to today's
emphasis on patient autonomy and self-determination.
[20]
In 1815, the Apothecaries Act was passed by the Parliament of the United
Kingdom. It introduced compulsory apprenticeship and formal qualifications
for the apothecaries of the day under the license of the Society of Apothecaries.
This was the beginning of regulation of the medical profession in the UK.
In 1847, the American Medical Association adopted its first code of ethics, with
this being based in large part upon Percival's work.
[21]
While the secularized
field borrowed largely from Catholic medical ethics, in the 20th century a
distinctively liberal Protestant approach was articulated by thinkers such
as Joseph Fletcher. In the 1960s and 1970s, building upon liberal
theory and procedural justice, much of the discourse of medical ethics went
through a dramatic shift and largely reconfigured itself into bioethics.
[22]
Well-known medical ethics cases include:
Albert Kligman's dermatology experiments
Deep sleep therapy
Doctors' Trial
Greenberg v. Miami Children's Hospital Research
Institute
Henrietta Lacks
Chester M. Southam's Cancer Injection Study
Human radiation experiments
Jesse Gelsinger
Moore v. Regents of the University of California
Surgical removal of body parts to try to improve
mental health
Medical Experimentation on Black Americans
Milgram experiment
Radioactive iodine experiments
The Monster Study
Plutonium injections
The David Reimer case
The Stanford Prison Experiment
Tuskegee syphilis experiment
Willowbrook State School
Yanomami blood sample collection
o Darkness in El Dorado
Since the 1970s, the growing influence of ethics in contemporary medicine can
be seen in the increasing use of Institutional Review Boards to evaluate
experiments on human subjects, the establishment of hospital ethics
committees, the expansion of the role of clinician ethicists, and the integration
of ethics into many medical school curricula.
[23]
Values[edit]
A common framework used when analysing medical ethics is the "four
principles" approach postulated by Tom Beauchamp and James Childress in
their textbook Principles of Biomedical Ethics. It recognizes four basic moral
principles, which are to be judged and weighed against each other, with
attention given to the scope of their application. The four principles are:
[24]
Respect for autonomy – the patient has the right to
refuse or choose their treatment.
[25]
Beneficence – a practitioner should act in the best
interest of the patient.
[25]
Non-maleficence – to not be the cause of harm. Also,
"Utility" – to promote more good than harm.
[25]
Justice – concerns the distribution of scarce health
resources, and the decision of who gets what
treatment.
[25]
Autonomy[edit]
The principle of autonomy, broken down into "autos" (self) and "nomos (rule),
views the rights of an individual to self-determination.
[20]
This is rooted in
society's respect for individuals' ability to make informed decisions about
personal matters with freedom. Autonomy has become more important as
social values have shifted to define medical quality in terms of outcomes that
are important to the patient and their family rather than medical
professionals.
[20]
The increasing importance of autonomy can be seen as a
social reaction against the " paternalistic" tradition within
healthcare.
[20][26]
Some have questioned whether the backl ash against
historically excessive paternalism in favor of patient autonomy has inhibited
the proper use of soft paternalism to the detriment of outcomes for some
patients.
[27]
The definition of autonomy is the ability of an individual to make a rational,
uninfluenced decision. Therefore, it can be said that autonomy is a general
The Stanford Prison Experiment
Tuskegee syphilis experiment
Willowbrook State School
Yanomami blood sample collection
o Darkness in El Dorado
Since the 1970s, the growing influence of ethics in contemporary medicine can
be seen in the increasing use of Institutional Review Boards to evaluate
experiments on human subjects, the establishment of hospital ethics
committees, the expansion of the role of clinician ethicists, and the integration
of ethics into many medical school curricula.
[23]
Values[edit]
A common framework used when analysing medical ethics is the "four
principles" approach postulated by Tom Beauchamp and James Childress in
their textbook Principles of Biomedical Ethics. It recognizes four basic moral
principles, which are to be judged and weighed against each other, with
attention given to the scope of their application. The four principles are:
[24]
Respect for autonomy – the patient has the right to
refuse or choose their treatment.
[25]
Beneficence – a practitioner should act in the best
interest of the patient.
[25]
Non-maleficence – to not be the cause of harm. Also,
"Utility" – to promote more good than harm.
[25]
Justice – concerns the distribution of scarce health
resources, and the decision of who gets what
treatment.
[25]
Autonomy[edit]
The principle of autonomy, broken down into "autos" (self) and "nomos (rule),
views the rights of an individual to self-determination.
[20]
This is rooted in
society's respect for individuals' ability to make informed decisions about
personal matters with freedom. Autonomy has become more important as
social values have shifted to define medical quality in terms of outcomes that
are important to the patient and their family rather than medical
professionals.
[20]
The increasing importance of autonomy can be seen as a
social reaction against the " paternalistic" tradition within
healthcare.
[20][26]
Some have questioned whether the backl ash against
historically excessive paternalism in favor of patient autonomy has inhibited
the proper use of soft paternalism to the detriment of outcomes for some
patients.
[27]
The definition of autonomy is the ability of an individual to make a rational,
uninfluenced decision. Therefore, it can be said that autonomy is a general
indicator of a healthy mind and body. The progression of many terminal
diseases are characterized by loss of autonomy, in various manners and
extents. For example, dementia, a chronic and progressive disease that attacks
the brain can induce memory loss and cause a decrease in rational thinking,
almost always results in the loss of autonomy.
[28]
Psychiatrists and clinical psychologists are often asked to evaluate a patient's
capacity for making life-and-death decisions at the end of life. Persons with a
psychiatric condition such as delirium or clinical depression may lack capacity
to make end-of-life decisions. For these persons, a request to refuse treatment
may be taken in the context of their condition. Unless there is a clear advance
directive to the contrary, persons lacking mental capacity are treated according
to their best interests. This will involve an assessment involving people who
know the person best to what decisions the person would have made had they
not lost capacity.
[29]
Persons with the mental capacity to make end -of-life
decisions may refuse treatment with the understanding that it may shorten
their life. Psychiatrists and psychologists may be involved to support decision
making.
[30]
Beneficence[edit]
Main article: Beneficence (ethics)
The term beneficence refers to actions that promote the well being of others. In
the medical context, this means taking actions that serve the best interests of
patients and their families.
[1]
However, uncertainty surrounds the precise
definition of which practices do in fact help patients.
James Childress and Tom Beauchamp in Principles of Biomedical Ethics (1978)
identify beneficence as one of the core values of healthcare ethics. Some
scholars, such as Edmund Pellegrino , argue that beneficence is
the only fundamental principle of medical ethics. They argue that healing
should be the sole purpose of medicine, and that endeavors like cosmetic
surgery and euthanasia are severely unethical and against the Hippocratic
Oath.
Non-maleficence[edit]
Main article: Primum non nocere
The concept of non-maleficence is embodied by the phrase, "first, do no harm,"
or the Latin, primum non nocere. Many consider that should be the main or
primary consideration (hence primum): that it is more important not to harm
your patient, than to do them good, which is part of the Hippocratic oath that
doctors take.
[31]
This is partly because enthusiastic practitioners are prone to
using treatments that they believe will do good, without first having evaluated
them adequately to ensure they do no harm to the patient. Much harm has
been done to patients as a result, as in the saying, "The treatment was a
success, but the patient died." It is not only more important to do no harm
than to do good; it is also important to know how likely it is that your
treatment will harm a patient. So a physician should go further than not
diseases are characterized by loss of autonomy, in various manners and
extents. For example, dementia, a chronic and progressive disease that attacks
the brain can induce memory loss and cause a decrease in rational thinking,
almost always results in the loss of autonomy.
[28]
Psychiatrists and clinical psychologists are often asked to evaluate a patient's
capacity for making life-and-death decisions at the end of life. Persons with a
psychiatric condition such as delirium or clinical depression may lack capacity
to make end-of-life decisions. For these persons, a request to refuse treatment
may be taken in the context of their condition. Unless there is a clear advance
directive to the contrary, persons lacking mental capacity are treated according
to their best interests. This will involve an assessment involving people who
know the person best to what decisions the person would have made had they
not lost capacity.
[29]
Persons with the mental capacity to make end -of-life
decisions may refuse treatment with the understanding that it may shorten
their life. Psychiatrists and psychologists may be involved to support decision
making.
[30]
Beneficence[edit]
Main article: Beneficence (ethics)
The term beneficence refers to actions that promote the well being of others. In
the medical context, this means taking actions that serve the best interests of
patients and their families.
[1]
However, uncertainty surrounds the precise
definition of which practices do in fact help patients.
James Childress and Tom Beauchamp in Principles of Biomedical Ethics (1978)
identify beneficence as one of the core values of healthcare ethics. Some
scholars, such as Edmund Pellegrino , argue that beneficence is
the only fundamental principle of medical ethics. They argue that healing
should be the sole purpose of medicine, and that endeavors like cosmetic
surgery and euthanasia are severely unethical and against the Hippocratic
Oath.
Non-maleficence[edit]
Main article: Primum non nocere
The concept of non-maleficence is embodied by the phrase, "first, do no harm,"
or the Latin, primum non nocere. Many consider that should be the main or
primary consideration (hence primum): that it is more important not to harm
your patient, than to do them good, which is part of the Hippocratic oath that
doctors take.
[31]
This is partly because enthusiastic practitioners are prone to
using treatments that they believe will do good, without first having evaluated
them adequately to ensure they do no harm to the patient. Much harm has
been done to patients as a result, as in the saying, "The treatment was a
success, but the patient died." It is not only more important to do no harm
than to do good; it is also important to know how likely it is that your
treatment will harm a patient. So a physician should go further than not
prescribing medications they know to be harmful —he or she should not
prescribe medications (or otherwise treat the patient) unless s/he knows that
the treatment is unlikely to be harmful; or at the very least, that patient
understands the risks and benefits, and that the likely benefits outweigh the
likely risks.
In practice, however, many treatments carry some risk of harm. In some
circumstances, e.g. in desperate situations where the outcome without
treatment will be grave, risky treatments that stand a high chance of harming
the patient will be justified, as the risk of not treating is also very likely to do
harm. So the principle of non-maleficence is not absolute, and balances against
the principle of beneficence (doing good), as the effects of the two principles
together often give rise to a double effect (further described in next section).
Even basic actions like taking a blood sample or an injection of a drug cause
harm to the patient's body. Euthanasia also goes against the principle of
beneficence because the patient dies as a result of the medical treatment by
the doctor.
Double effect[edit]
Main article: Principle of double effect
Double effect refers to two types of consequences that may be produced by a
single action,
[32]
and in medical ethics it is usually regarded as the combined
effect of beneficence and non-maleficence.
[33]
A commonly cited example of this phenomenon is the use of morphine or
other analgesic in the dying patient. Such use of morphine can have the
beneficial effect of easing the pain and suffering of the patient while
simultaneously having the maleficent effect of shortening the life of the patient
through the deactivation of the respiratory system.
[34]
Respect for human rights[edit]
The human rights era started with the formation of the United Nations in 1945,
which was charged with the promotion of human rights. The Universal
Declaration of Human Rights (1948) was the first major document to define
human rights. Medical doctors have an ethical duty to protect the human
rights and human dignity of the patient so the advent of a document that
defines human rights has had its effect on medical ethics.
[35]
Most codes of
medical ethics now require respect for the human rights of the patient.
The Council of Europe promotes the rule of law and observance of human
rights in Europe. The Council of Europe adopted the European Convention on
Human Rights and Biomedicin e (1997) to create a uniform code of medical
ethics for its 47 member-states. The Convention applies international human
rights law to medical ethics. It provides special protection of physical integrity
for those who are unable to consent, which includes children.
No organ or tissue removal may be carried out on a person who does not have
the capacity to consent under Article 5.
[36]
prescribe medications (or otherwise treat the patient) unless s/he knows that
the treatment is unlikely to be harmful; or at the very least, that patient
understands the risks and benefits, and that the likely benefits outweigh the
likely risks.
In practice, however, many treatments carry some risk of harm. In some
circumstances, e.g. in desperate situations where the outcome without
treatment will be grave, risky treatments that stand a high chance of harming
the patient will be justified, as the risk of not treating is also very likely to do
harm. So the principle of non-maleficence is not absolute, and balances against
the principle of beneficence (doing good), as the effects of the two principles
together often give rise to a double effect (further described in next section).
Even basic actions like taking a blood sample or an injection of a drug cause
harm to the patient's body. Euthanasia also goes against the principle of
beneficence because the patient dies as a result of the medical treatment by
the doctor.
Double effect[edit]
Main article: Principle of double effect
Double effect refers to two types of consequences that may be produced by a
single action,
[32]
and in medical ethics it is usually regarded as the combined
effect of beneficence and non-maleficence.
[33]
A commonly cited example of this phenomenon is the use of morphine or
other analgesic in the dying patient. Such use of morphine can have the
beneficial effect of easing the pain and suffering of the patient while
simultaneously having the maleficent effect of shortening the life of the patient
through the deactivation of the respiratory system.
[34]
Respect for human rights[edit]
The human rights era started with the formation of the United Nations in 1945,
which was charged with the promotion of human rights. The Universal
Declaration of Human Rights (1948) was the first major document to define
human rights. Medical doctors have an ethical duty to protect the human
rights and human dignity of the patient so the advent of a document that
defines human rights has had its effect on medical ethics.
[35]
Most codes of
medical ethics now require respect for the human rights of the patient.
The Council of Europe promotes the rule of law and observance of human
rights in Europe. The Council of Europe adopted the European Convention on
Human Rights and Biomedicin e (1997) to create a uniform code of medical
ethics for its 47 member-states. The Convention applies international human
rights law to medical ethics. It provides special protection of physical integrity
for those who are unable to consent, which includes children.
No organ or tissue removal may be carried out on a person who does not have
the capacity to consent under Article 5.
[36]
As of December 2013, the Convention had been ratified or acceded to by
twenty-nine member-states of the Council of Europe.
[37]
The United Nations Educational, Scientific and Cultural
Organization (UNESCO) also promotes the protection of human rights
and human dignity. According to UNESCO, "Declarations are another means of
defining norms, which are not subject to ratification. Like recommendations,
they set forth universal principles to which the community of States wished to
attribute the greatest possible authority and to afford the broadest possible
support." UNESCO adopted the Universal Declaration on Human Rights and
Biomedicine to advance the application of international human rights law in
medical ethics. The Declaration provides special protection of human rights for
incompetent persons.
In applying and advancing scientific knowledge, medi cal practice and
associated technologies, human vulnerability should be taken into account.
Individuals and groups of special vulnerability should be protected and the
personal integrity of such individuals respected.
[38]
Solidarity[edit]
Individualistic standards of autonomy and personal human rights as t hey
relate to social justice seen in the Anglo-Saxon community, clash with and can
also supplement the concept of solidarity, which stands closer to a European
healthcare perspective focused on community, universal welfare, and the
unselfish wish to provide healthcare equally for all.
[39]
In the United States
individualistic and self-interested healthcare norms are upheld, whereas in
other countries, including European countries, a sense of respect for the
community and personal support is more greatly upheld in relation to free
healthcare.
[39]
Acceptance of ambiguity in medicine[edit]
The concept of normality, that there is a human physiological standard
contrasting with conditions of illness, abnor mality and pain, leads to
assumptions and bias that negatively affects health care practice.
[40]
It is
important to realize that normality is ambiguous and that ambiguity in
healthcare and the acceptance of such ambiguity is necessary in order to
practice humbler medicine and understand complex, sometimes unusual usual
medical cases.
[40]
Thus, society's views on central concepts in philosophy and
clinical beneficence must be questioned and revisited, adopting ambiguity as a
central player in medical practice.
[40]
Conflicts[edit]
Between autonomy and beneficence/non -maleficence[edit]
Autonomy can come into conflict with beneficence when patients disagree with
recommendations that healthcare professionals believe are in the patient's best
interest. When the patient's interests conflict with the patient's welfare,
twenty-nine member-states of the Council of Europe.
[37]
The United Nations Educational, Scientific and Cultural
Organization (UNESCO) also promotes the protection of human rights
and human dignity. According to UNESCO, "Declarations are another means of
defining norms, which are not subject to ratification. Like recommendations,
they set forth universal principles to which the community of States wished to
attribute the greatest possible authority and to afford the broadest possible
support." UNESCO adopted the Universal Declaration on Human Rights and
Biomedicine to advance the application of international human rights law in
medical ethics. The Declaration provides special protection of human rights for
incompetent persons.
In applying and advancing scientific knowledge, medi cal practice and
associated technologies, human vulnerability should be taken into account.
Individuals and groups of special vulnerability should be protected and the
personal integrity of such individuals respected.
[38]
Solidarity[edit]
Individualistic standards of autonomy and personal human rights as t hey
relate to social justice seen in the Anglo-Saxon community, clash with and can
also supplement the concept of solidarity, which stands closer to a European
healthcare perspective focused on community, universal welfare, and the
unselfish wish to provide healthcare equally for all.
[39]
In the United States
individualistic and self-interested healthcare norms are upheld, whereas in
other countries, including European countries, a sense of respect for the
community and personal support is more greatly upheld in relation to free
healthcare.
[39]
Acceptance of ambiguity in medicine[edit]
The concept of normality, that there is a human physiological standard
contrasting with conditions of illness, abnor mality and pain, leads to
assumptions and bias that negatively affects health care practice.
[40]
It is
important to realize that normality is ambiguous and that ambiguity in
healthcare and the acceptance of such ambiguity is necessary in order to
practice humbler medicine and understand complex, sometimes unusual usual
medical cases.
[40]
Thus, society's views on central concepts in philosophy and
clinical beneficence must be questioned and revisited, adopting ambiguity as a
central player in medical practice.
[40]
Conflicts[edit]
Between autonomy and beneficence/non -maleficence[edit]
Autonomy can come into conflict with beneficence when patients disagree with
recommendations that healthcare professionals believe are in the patient's best
interest. When the patient's interests conflict with the patient's welfare,
different societies settle the conflict in a wide range of manners. In general,
Western medicine defers to the wishes of a mentally competent patient to make
their own decisions, even in cases where the medical team believes that they
are not acting in their own best interests. However, many other societies
prioritize beneficence over autonomy.
Examples include when a patient does not want a treatment because of, for
example, religious or cultural views. In the case of euthanasia, the patient, or
relatives of a patient, may want to end the life of the patient. Also, the patient
may want an unnecessary treatment, as can be the case in hypochondria or
with cosmetic surgery; here, the practitioner may be required to balance the
desires of the patient for medically unnecessary potential risks against the
patient's informed autonomy in the issue. A doctor may want to prefer
autonomy because refusal to please the patient's self-determination would
harm the doctor-patient relationship.
Organ donations can sometimes pose interesting scenarios, in which a patient
is classified as a non-heart beating donor (NHBD), where life support fails to
restore the heartbeat and is now considered futile but brain death has not
occurred. Classifying a patient as a NHBD can qualify someone to be subject to
non-therapeutic intensive care, in which treatment is only given to preserve the
organs that will be donated and not to preserve the life of the donor. This can
bring up ethical issues as some may see respect for the donors wishes to
donate their healthy organs as respect for autonomy, while others may view the
sustaining of futile treatment during vegetative state maleficence for the patient
and the patient's family. Some are worried making this process a worldwide
customary measure may dehumanize and take away from the natural process
of dying and what it brings along with it.
Individuals' capacity for informed decision-making may come into question
during resolution of conflicts between autonomy and beneficence. The role of
surrogate medical decision-makers is an extension of the principl e of
autonomy.
On the other hand, autonomy and beneficence/non -maleficence may also
overlap. For example, a breach of patients' autonomy may cause decreased
confidence for medical services in the population and subsequently less
willingness to seek help, which in turn may cause inability to perform
beneficence.
The principles of autonomy and beneficence/non -maleficence may also be
expanded to include effects on the relatives of patients or even the medical
practitioners, the overall population and economic issues when making medical
decisions.
Euthanasia[edit]
Main article: Euthanasia
There is disagreement among American physicians as to whether the non -
maleficence principle excludes the practice of euthanasia. Euthanasia is
Western medicine defers to the wishes of a mentally competent patient to make
their own decisions, even in cases where the medical team believes that they
are not acting in their own best interests. However, many other societies
prioritize beneficence over autonomy.
Examples include when a patient does not want a treatment because of, for
example, religious or cultural views. In the case of euthanasia, the patient, or
relatives of a patient, may want to end the life of the patient. Also, the patient
may want an unnecessary treatment, as can be the case in hypochondria or
with cosmetic surgery; here, the practitioner may be required to balance the
desires of the patient for medically unnecessary potential risks against the
patient's informed autonomy in the issue. A doctor may want to prefer
autonomy because refusal to please the patient's self-determination would
harm the doctor-patient relationship.
Organ donations can sometimes pose interesting scenarios, in which a patient
is classified as a non-heart beating donor (NHBD), where life support fails to
restore the heartbeat and is now considered futile but brain death has not
occurred. Classifying a patient as a NHBD can qualify someone to be subject to
non-therapeutic intensive care, in which treatment is only given to preserve the
organs that will be donated and not to preserve the life of the donor. This can
bring up ethical issues as some may see respect for the donors wishes to
donate their healthy organs as respect for autonomy, while others may view the
sustaining of futile treatment during vegetative state maleficence for the patient
and the patient's family. Some are worried making this process a worldwide
customary measure may dehumanize and take away from the natural process
of dying and what it brings along with it.
Individuals' capacity for informed decision-making may come into question
during resolution of conflicts between autonomy and beneficence. The role of
surrogate medical decision-makers is an extension of the principl e of
autonomy.
On the other hand, autonomy and beneficence/non -maleficence may also
overlap. For example, a breach of patients' autonomy may cause decreased
confidence for medical services in the population and subsequently less
willingness to seek help, which in turn may cause inability to perform
beneficence.
The principles of autonomy and beneficence/non -maleficence may also be
expanded to include effects on the relatives of patients or even the medical
practitioners, the overall population and economic issues when making medical
decisions.
Euthanasia[edit]
Main article: Euthanasia
There is disagreement among American physicians as to whether the non -
maleficence principle excludes the practice of euthanasia. Euthanasia is
currently legal in the states of Washington, DC, California, Colorado, Oregon,
Vermont, and Washington.
[41]
Around the world, there are different
organizations that campaign to change legislation about the issue of physician-
assisted death, or PAD. Examples of such organizations are the Hemlock
Society of the United States and the Dignity in Dying campaign in the United
Kingdom.
[42]
These groups believe that doctors should be given the right to end
a patient's life only if the patient is conscious enough to decide for themselves,
is knowledgeable about the possibility of alternative care, and has willingly
asked to end their life or requested access to the means to do so.
This argument is disputed in other parts of the world. For example, in the state
of Louisiana, giving advice or supplying the means to end a person's life is
considered a criminal act and can be charged as a felony.
[43]
In state courts,
this crime is comparable to manslaughter.
[44]
The same laws apply in the states
of Mississippi and Nebraska.
[45]
Informed consent [edit]
Main article: Informed consent
Informed consent in ethics usually refers to the idea that a person must be
fully informed about and understand the potential benefits and risks of their
choice of treatment.
[46]
A correlate to "informed consent" is the concept
of informed refusal. An uninformed person is at risk of mistakenly making a
choice not reflective of his or her values or wishes. It does not specifically mean
the process of obtaining consent, or the specific legal requirements, which vary
from place to place, for capacity to consent. Patients can elect to make their
own medical decisions or can delegate decision-making authority to another
party.
[47]
If the patient is incapacitated, laws around the world designate
different processes for obtaining informed consent, typically by having a person
appointed by the patient or their next of kin make decisions for them.
[48]
The
value of informed consent is closely related to the values of autonomy and
truth telling.
Confidentiality [edit]
Further information: Confidentiality
Confidentiality is commonly applied to conversations between doctors and
patients.
[49]
This concept is commonly known as patient -physician privilege.
Legal protections prevent physicians from revealing their discussions with
patients, even under oath in court.
Confidentiality is mandated in the United States by the Health Insurance
Portability and Accountability Act of 1996 known as HIPAA,
[50]
specifically the
Privacy Rule, and various state laws, some more rigorous than HIPAA.
However, numerous exceptions to the rules have been carved out over the
years. For example, many states require physicians to report gunshot wounds
to the police and impaired drivers to the Department of Motor Vehicles.
Confidentiality is also challenged in cases involving the diagnosis of a sexually
Vermont, and Washington.
[41]
Around the world, there are different
organizations that campaign to change legislation about the issue of physician-
assisted death, or PAD. Examples of such organizations are the Hemlock
Society of the United States and the Dignity in Dying campaign in the United
Kingdom.
[42]
These groups believe that doctors should be given the right to end
a patient's life only if the patient is conscious enough to decide for themselves,
is knowledgeable about the possibility of alternative care, and has willingly
asked to end their life or requested access to the means to do so.
This argument is disputed in other parts of the world. For example, in the state
of Louisiana, giving advice or supplying the means to end a person's life is
considered a criminal act and can be charged as a felony.
[43]
In state courts,
this crime is comparable to manslaughter.
[44]
The same laws apply in the states
of Mississippi and Nebraska.
[45]
Informed consent [edit]
Main article: Informed consent
Informed consent in ethics usually refers to the idea that a person must be
fully informed about and understand the potential benefits and risks of their
choice of treatment.
[46]
A correlate to "informed consent" is the concept
of informed refusal. An uninformed person is at risk of mistakenly making a
choice not reflective of his or her values or wishes. It does not specifically mean
the process of obtaining consent, or the specific legal requirements, which vary
from place to place, for capacity to consent. Patients can elect to make their
own medical decisions or can delegate decision-making authority to another
party.
[47]
If the patient is incapacitated, laws around the world designate
different processes for obtaining informed consent, typically by having a person
appointed by the patient or their next of kin make decisions for them.
[48]
The
value of informed consent is closely related to the values of autonomy and
truth telling.
Confidentiality [edit]
Further information: Confidentiality
Confidentiality is commonly applied to conversations between doctors and
patients.
[49]
This concept is commonly known as patient -physician privilege.
Legal protections prevent physicians from revealing their discussions with
patients, even under oath in court.
Confidentiality is mandated in the United States by the Health Insurance
Portability and Accountability Act of 1996 known as HIPAA,
[50]
specifically the
Privacy Rule, and various state laws, some more rigorous than HIPAA.
However, numerous exceptions to the rules have been carved out over the
years. For example, many states require physicians to report gunshot wounds
to the police and impaired drivers to the Department of Motor Vehicles.
Confidentiality is also challenged in cases involving the diagnosis of a sexually
transmitted disease in a patient who refuses to reveal the diagnosis to a
spouse, and in the termination of a pregnancy in an underage patient, without
the knowledge of the patient's parents. Many states in the U.S. have laws
governing parental notification in underage abortion.
[51][52]
Those working in
mental health have a duty to warn those who they deem to be at risk from their
patients in some countries.
[53]
Traditionally, medical ethics has viewed the duty of confidentiality as a
relatively non-negotiable tenet of medical practice. More recently, critics
like Jacob Appel have argued for a more nuanced approach to the duty that
acknowledges the need for flexibility in many cases.
[11]
Confidentiality is an important issue in primary care ethics, where physicians
care for many patients from the same family and community, and where third
parties often request information from the considerable medical database
typically gathered in primary health care.
Privacy and the Internet [edit]
In increasing frequency, medical researchers are researching activities in online
environments such as discussion boards and bulletin boards, and there is
concern that the requirements of informed consent and privacy are not applied,
although some guidelines do exist.
[54]
One issue that has arisen, however, is the disclosure of information. While
researchers wish to quote from the original source in order to argue a point,
this can have repercussions when the identity of the patient is not kept
confidential. The quotations and other information about the site can be used
to identify the patient, and researchers have reported cases where members of
the site, bloggers and others have used this information as 'clues' in a game in
an attempt to identify the site.
[55]
Some researchers have employed various
methods of "heavy disguise."
[55]
including discussing a different condition from
that under study.
[56][57]
Healthcare institutions' websites have the responsibility to ensure that the
private medical records of their online visitors are secure from being marketed
and monetized into the hands of drug companies, occupation records, and
insurance companies. The delivery of diagnosis online leads patients to believe
that doctors in some parts of the country are at the direct service of drug
companies, finding diagnosis as convenient as what drug still has patent rights
on it.
[58]
Physicians and drug companies are found to be competing for top ten
search engine ranks to lower costs of selling these drugs with little to no
patient involvement.
[59]
]
With the expansion of internet healthcare platforms, online practitioner
legitimacy and privacy accountability face unique challenges such as e -
paparazzi, online information brokers, industrial spies, unlicensed information
providers that work outside of traditional medical codes for profit. The
American Medical Association (AMA) states that medical websites have the
responsibility to ensure the health care privacy of online visitors and protect
spouse, and in the termination of a pregnancy in an underage patient, without
the knowledge of the patient's parents. Many states in the U.S. have laws
governing parental notification in underage abortion.
[51][52]
Those working in
mental health have a duty to warn those who they deem to be at risk from their
patients in some countries.
[53]
Traditionally, medical ethics has viewed the duty of confidentiality as a
relatively non-negotiable tenet of medical practice. More recently, critics
like Jacob Appel have argued for a more nuanced approach to the duty that
acknowledges the need for flexibility in many cases.
[11]
Confidentiality is an important issue in primary care ethics, where physicians
care for many patients from the same family and community, and where third
parties often request information from the considerable medical database
typically gathered in primary health care.
Privacy and the Internet [edit]
In increasing frequency, medical researchers are researching activities in online
environments such as discussion boards and bulletin boards, and there is
concern that the requirements of informed consent and privacy are not applied,
although some guidelines do exist.
[54]
One issue that has arisen, however, is the disclosure of information. While
researchers wish to quote from the original source in order to argue a point,
this can have repercussions when the identity of the patient is not kept
confidential. The quotations and other information about the site can be used
to identify the patient, and researchers have reported cases where members of
the site, bloggers and others have used this information as 'clues' in a game in
an attempt to identify the site.
[55]
Some researchers have employed various
methods of "heavy disguise."
[55]
including discussing a different condition from
that under study.
[56][57]
Healthcare institutions' websites have the responsibility to ensure that the
private medical records of their online visitors are secure from being marketed
and monetized into the hands of drug companies, occupation records, and
insurance companies. The delivery of diagnosis online leads patients to believe
that doctors in some parts of the country are at the direct service of drug
companies, finding diagnosis as convenient as what drug still has patent rights
on it.
[58]
Physicians and drug companies are found to be competing for top ten
search engine ranks to lower costs of selling these drugs with little to no
patient involvement.
[59]
]
With the expansion of internet healthcare platforms, online practitioner
legitimacy and privacy accountability face unique challenges such as e -
paparazzi, online information brokers, industrial spies, unlicensed information
providers that work outside of traditional medical codes for profit. The
American Medical Association (AMA) states that medical websites have the
responsibility to ensure the health care privacy of online visitors and protect
patient records from being marketed and monetized into the hands of
insurance companies, employers, and marketers. [40] With the rapid
unification of healthcare, business practices, computer science and e -
commerce to create these online diagnostic websites, efforts to maintain health
care system's ethical confidentiality standard need to keep up as well. Over the
next few years, the Department of Health and Human Services has stated that
they will be working towards lawfully protecting the online privacy and digital
transfers of patient Electronic Medical Records (EMR) under The Health
Insurance Portability and Accountability Act (HIPAA). [41]
Control and resolution[edit]
To ensure that appropriate ethical values are being applied within hospitals,
effective hospital accreditation requires that ethical considerations are taken
into account, for example with respect to physician integrity, conflict of
interest, research ethics and organ transplantation ethics.
Guidelines
There is much documentation of the history and necessity of the Declaration of
Helsinki. The first code of conduct for research including medical ethics was
the Nuremberg Code. This document had large ties to Nazi war crimes, as it
was introduced in 1997, so it didn't make much of a difference in terms of
regulating practice. This issue called for the creation of the Declaration. There
are some stark differences between the Nuremberg Code and the Declaration of
Helsinki, including the way it is written. Nuremberg was written in a very
concise manner, with a simple explanation. The Declaration of Helsinki is
written with a thorough explanation in mind and including many specific
commentaries.
[60]
In the United Kingdom, General Medical Council provides clear overall modern
guidance in the form of its 'Good Medical Practice' statement.
[61]
Other
organizations, such as the Medical Protection Society and a number of
university departments, are often consulted by British doctors regarding issues
relating to ethics.
Ethics committees
Often, simple communication is not enough to resolve a conflict, and a
hospital ethics committee must convene to decide a complex matter.
These bodies are composed primarily of healthcare professionals, but may also
include philosophers, lay people, and clergy – indeed, in many parts of the
world their presence is considered mandatory in order to provide balance.
With respect to the expected composition of such bodies in the US, Europe and
Australia, the following applies.
[62]
U.S. recommendations suggest that Research and Ethical Boards (REBs)
should have five or more members, including at least one scientist, one non-
scientist, and one person not affiliated with the institution.
[63]
The REB should
insurance companies, employers, and marketers. [40] With the rapid
unification of healthcare, business practices, computer science and e -
commerce to create these online diagnostic websites, efforts to maintain health
care system's ethical confidentiality standard need to keep up as well. Over the
next few years, the Department of Health and Human Services has stated that
they will be working towards lawfully protecting the online privacy and digital
transfers of patient Electronic Medical Records (EMR) under The Health
Insurance Portability and Accountability Act (HIPAA). [41]
Control and resolution[edit]
To ensure that appropriate ethical values are being applied within hospitals,
effective hospital accreditation requires that ethical considerations are taken
into account, for example with respect to physician integrity, conflict of
interest, research ethics and organ transplantation ethics.
Guidelines
There is much documentation of the history and necessity of the Declaration of
Helsinki. The first code of conduct for research including medical ethics was
the Nuremberg Code. This document had large ties to Nazi war crimes, as it
was introduced in 1997, so it didn't make much of a difference in terms of
regulating practice. This issue called for the creation of the Declaration. There
are some stark differences between the Nuremberg Code and the Declaration of
Helsinki, including the way it is written. Nuremberg was written in a very
concise manner, with a simple explanation. The Declaration of Helsinki is
written with a thorough explanation in mind and including many specific
commentaries.
[60]
In the United Kingdom, General Medical Council provides clear overall modern
guidance in the form of its 'Good Medical Practice' statement.
[61]
Other
organizations, such as the Medical Protection Society and a number of
university departments, are often consulted by British doctors regarding issues
relating to ethics.
Ethics committees
Often, simple communication is not enough to resolve a conflict, and a
hospital ethics committee must convene to decide a complex matter.
These bodies are composed primarily of healthcare professionals, but may also
include philosophers, lay people, and clergy – indeed, in many parts of the
world their presence is considered mandatory in order to provide balance.
With respect to the expected composition of such bodies in the US, Europe and
Australia, the following applies.
[62]
U.S. recommendations suggest that Research and Ethical Boards (REBs)
should have five or more members, including at least one scientist, one non-
scientist, and one person not affiliated with the institution.
[63]
The REB should
include people knowledgeable in the law and standards of practice and
professional conduct.
[63]
Special memberships are advocated for handicapped
or disabled concerns, if required by the protocol under review.
The European Forum for Good Clinical Practice (EFGCP) suggests that REBs
include two practicing physicians who share experience in biomedical research
and are independent from the institution where the research is conducted; one
lay person; one lawyer; and one paramedical professional, e.g. nurse or
pharmacist. They recommend that a quorum include both sexes from a wide
age range and reflect the cultural make-up of the local community.
The 1996 Australian Health Ethics Committee recommendations were entitled,
"Membership Generally of Institutional Ethics Committees". They suggest a
chairperson be preferably someone not employed or otherwise connected with
the institution. Members should include a person with knowledge and
experience in professional care, counseling or treatment of humans; a minister
of religion or equivalent, e.g. Aboriginal elder; a layman; a laywoman; a lawyer
and, in the case of a hospital-based ethics committee, a nurse.
The assignment of philosophers or religious clerics will reflect the importance
attached by the society to the basic values involved. An example
from Sweden with Torbjörn Tännsjö on a couple of such committees
indicates secular trends gaining influence.
Cultural concerns
Cultural differences can create difficult medical ethics problems. Some cultures
have spiritual or magical theories about the origins and cause of disease, for
example, and reconciling these beliefs with the tenets of Western medicine can
be very difficult. As different cultures continue to intermingle and more
cultures live alongside each other, the healthcare system, which tends to deal
with important life events such as birth, death and suffering, increasingly
experiences difficult dilemmas that can sometimes lead to cultural clashes and
conflict. Efforts to respond in a culturally sensitive manner go hand in hand
with a need to distinguish limits to cultural tolerance.
[9]
Culture and language
As more people from different cultural and religious backgrounds move to other
countries, among these, the United States, it is becoming increa singly
important to be culturally sensitive to all communities in order to provide the
best health care for all people.
[10]
Lack of cultural knowledge can lead to
misunderstandings and even inadequate care, which can lead to ethical
problems. A common complaint patients have is feeling like they are not being
heard, or perhaps, understood.
[10]
Preventing escalating conflict can be
accomplished by seeking interpreters, noticing body language and tone of both
yourself and the patient as well as attempting to understand the patient's
perspective in order to reach an acceptable option.
[10]
professional conduct.
[63]
Special memberships are advocated for handicapped
or disabled concerns, if required by the protocol under review.
The European Forum for Good Clinical Practice (EFGCP) suggests that REBs
include two practicing physicians who share experience in biomedical research
and are independent from the institution where the research is conducted; one
lay person; one lawyer; and one paramedical professional, e.g. nurse or
pharmacist. They recommend that a quorum include both sexes from a wide
age range and reflect the cultural make-up of the local community.
The 1996 Australian Health Ethics Committee recommendations were entitled,
"Membership Generally of Institutional Ethics Committees". They suggest a
chairperson be preferably someone not employed or otherwise connected with
the institution. Members should include a person with knowledge and
experience in professional care, counseling or treatment of humans; a minister
of religion or equivalent, e.g. Aboriginal elder; a layman; a laywoman; a lawyer
and, in the case of a hospital-based ethics committee, a nurse.
The assignment of philosophers or religious clerics will reflect the importance
attached by the society to the basic values involved. An example
from Sweden with Torbjörn Tännsjö on a couple of such committees
indicates secular trends gaining influence.
Cultural concerns
Cultural differences can create difficult medical ethics problems. Some cultures
have spiritual or magical theories about the origins and cause of disease, for
example, and reconciling these beliefs with the tenets of Western medicine can
be very difficult. As different cultures continue to intermingle and more
cultures live alongside each other, the healthcare system, which tends to deal
with important life events such as birth, death and suffering, increasingly
experiences difficult dilemmas that can sometimes lead to cultural clashes and
conflict. Efforts to respond in a culturally sensitive manner go hand in hand
with a need to distinguish limits to cultural tolerance.
[9]
Culture and language
As more people from different cultural and religious backgrounds move to other
countries, among these, the United States, it is becoming increa singly
important to be culturally sensitive to all communities in order to provide the
best health care for all people.
[10]
Lack of cultural knowledge can lead to
misunderstandings and even inadequate care, which can lead to ethical
problems. A common complaint patients have is feeling like they are not being
heard, or perhaps, understood.
[10]
Preventing escalating conflict can be
accomplished by seeking interpreters, noticing body language and tone of both
yourself and the patient as well as attempting to understand the patient's
perspective in order to reach an acceptable option.
[10]
Some believe most medical practitioners in the future will have to be or greatly
benefit from being bilingual. In addition to knowing the language, truly
understanding culture is best for optimal care.
[64]
Recently, a practice called
'narrative medicine' has gained some interest as it has a potential for improving
patient-physician communication and underst anding of patient's perspective.
Interpreting a patient's stories or day-to-day activities as opposed to
standardizing and collecting patient data may help in acquiring a better sense
of what each patient needs, individually, with respect to their illness. Without
this background information, many physicians are unable to properly
understand the cultural differences that may set two different patients apart,
and thus, may diagnose or recommend treatments that are culturally
insensitive or inappropriate. In short, patient narrative has the potential for
uncovering patient information and preferences that may otherwise be
overlooked.
Medical humanitarianism
In order to address the underserved, uneducated communities in need of
nutrition, housing, and healthcare disparities seen in much of the world today,
some argue that we must fall back on ethical values in order to create a
foundation to move towards a reasonable understanding, which encourages
commitment and motivation to improve factors causing premature d eath as a
goal in a global community.
[12]
Such factors – such as poverty, environment
and education – are said to be out of national or individual control and so this
commitment is by default a social and communal responsibility placed on
global communities that are able to aid others in need.
[12]
This is based on the
framework of 'provincial globalism,' which seeks a world in which all people
have the capability to be healthy.
[12]
One concern regarding the intersection of medical ethics and humanitarian
medical aid is how medical assistance can be as harmful as it is helpful to the
community being served. One such example being how political forces may
control how foreign humanitarian aid can be utilized in the region it is meant
to be provided in. This would be congruous in situations where political strife
could lead such aid being used in favor of one group over another. Another
example of how foreign humanitarian aid can be misused in its intended
community includes the possibility of dissonance forming between a foreign
humanitarian aid group and the community being served.
[65]
Examples of this
could include the relationships being viewed between aid workers, style of
dress, or the lack of education regarding local culture and customs.
[66]
Humanitarian practices in areas lacking optimum care can also pause other
interesting and difficult ethical dilemmas in terms of beneficence and non-
maleficence. Humanitarian practices are based upon providing better medical
equipment and care for communities whose country does not provide adequate
healthcare.
[67]
The issues with providing healthcare to communities in need
may sometimes be religious or cultural backgrounds keeping people from
performing certain procedures or taking certain drugs. On the other hand,
benefit from being bilingual. In addition to knowing the language, truly
understanding culture is best for optimal care.
[64]
Recently, a practice called
'narrative medicine' has gained some interest as it has a potential for improving
patient-physician communication and underst anding of patient's perspective.
Interpreting a patient's stories or day-to-day activities as opposed to
standardizing and collecting patient data may help in acquiring a better sense
of what each patient needs, individually, with respect to their illness. Without
this background information, many physicians are unable to properly
understand the cultural differences that may set two different patients apart,
and thus, may diagnose or recommend treatments that are culturally
insensitive or inappropriate. In short, patient narrative has the potential for
uncovering patient information and preferences that may otherwise be
overlooked.
Medical humanitarianism
In order to address the underserved, uneducated communities in need of
nutrition, housing, and healthcare disparities seen in much of the world today,
some argue that we must fall back on ethical values in order to create a
foundation to move towards a reasonable understanding, which encourages
commitment and motivation to improve factors causing premature d eath as a
goal in a global community.
[12]
Such factors – such as poverty, environment
and education – are said to be out of national or individual control and so this
commitment is by default a social and communal responsibility placed on
global communities that are able to aid others in need.
[12]
This is based on the
framework of 'provincial globalism,' which seeks a world in which all people
have the capability to be healthy.
[12]
One concern regarding the intersection of medical ethics and humanitarian
medical aid is how medical assistance can be as harmful as it is helpful to the
community being served. One such example being how political forces may
control how foreign humanitarian aid can be utilized in the region it is meant
to be provided in. This would be congruous in situations where political strife
could lead such aid being used in favor of one group over another. Another
example of how foreign humanitarian aid can be misused in its intended
community includes the possibility of dissonance forming between a foreign
humanitarian aid group and the community being served.
[65]
Examples of this
could include the relationships being viewed between aid workers, style of
dress, or the lack of education regarding local culture and customs.
[66]
Humanitarian practices in areas lacking optimum care can also pause other
interesting and difficult ethical dilemmas in terms of beneficence and non-
maleficence. Humanitarian practices are based upon providing better medical
equipment and care for communities whose country does not provide adequate
healthcare.
[67]
The issues with providing healthcare to communities in need
may sometimes be religious or cultural backgrounds keeping people from
performing certain procedures or taking certain drugs. On the other hand,
wanting certain procedures done in a specific manner due to religious or
cultural belief systems may also occur. The ethical dilemma stems from
differences in culture between communities helping those with medical
disparities and the societies receiving aid. Women's rights, informed consent
and education about health become controversial, as some treatments needed
are against societal law, while some cultural traditions involve procedures
against humanitarian efforts.
[67]
Examples of this are female genital
mutilation (FGM), aiding in reinfibulation, providing sterile equipment in order
to perform procedures such as FGM, as well as informing patients of their HIV
positive testing. The latter is controversial because certain communities have in
the past outcast or killed HIV positive individuals.
[67]
Healthcare reform and lifestyle
Leading causes of death in the United States and around the world are highly
related to behavioral consequences o ver genetic or environmental
factors.
[68]
This leads some to believe true healthcare reform begins with
cultural reform, habit and overall lifestyle.
[68]
Lifestyle, then, becomes the cause
of many illnesses and the illnesses themselves are the result or side-effect of a
larger problem.
[68]
Some people believe this to be true and think that cultural
change is needed in order for developing societies to cope and dodge the
negative effects of drugs, food and conventional modes of transportation
available to them.
[68]
In 1990, tobacco use, diet, and exercise alone accounted
for close to 80 percent of all premature deaths and continue to lead in this way
through the 21st century.
[68]
Heart disease, stroke, dementia, and diabetes are
some of the diseases that may be affected by habit -forming patterns
throughout our life.
[68]
Some believe that medical lifestyle counseling and
building healthy habits around our daily lives is one way to tackle health care
reform.
[68]
Other cultures and healthcare
Buddhist medicine
Buddhist ethics and medicine are based on religious teachings of compassion
and understanding
[69]
of suffering and cause and effect and the idea that there
is no beginning or end to life, but that instead there are only rebirths in an
endless cycle.
[9]
In this way, death is merely a phase in an indefinitely lengthy
process of life, not an end. However, Buddhist teachings support living one's
life to the fullest so that through all the suffering which encompasses a large
part of what is life, there are no regrets. Buddhism accepts suffering as an
inescapable experience, but values happiness and thus values life.
[9]
Because
of this suicide, and euthanasia, are prohibited. However, attempts to rid
oneself of any physical or mental pain and suffering are seen as good acts. On
the other hand, sedatives and drugs are thought to impair consciousness and
awareness in the dying process, which is believed to be of great importance, as
it is thought that one's dying consciousness remains and affects new life.
Because of this, analgesics must not be part of the dying process, in order for
the dying person to be present entirely and pass on their consciousness
cultural belief systems may also occur. The ethical dilemma stems from
differences in culture between communities helping those with medical
disparities and the societies receiving aid. Women's rights, informed consent
and education about health become controversial, as some treatments needed
are against societal law, while some cultural traditions involve procedures
against humanitarian efforts.
[67]
Examples of this are female genital
mutilation (FGM), aiding in reinfibulation, providing sterile equipment in order
to perform procedures such as FGM, as well as informing patients of their HIV
positive testing. The latter is controversial because certain communities have in
the past outcast or killed HIV positive individuals.
[67]
Healthcare reform and lifestyle
Leading causes of death in the United States and around the world are highly
related to behavioral consequences o ver genetic or environmental
factors.
[68]
This leads some to believe true healthcare reform begins with
cultural reform, habit and overall lifestyle.
[68]
Lifestyle, then, becomes the cause
of many illnesses and the illnesses themselves are the result or side-effect of a
larger problem.
[68]
Some people believe this to be true and think that cultural
change is needed in order for developing societies to cope and dodge the
negative effects of drugs, food and conventional modes of transportation
available to them.
[68]
In 1990, tobacco use, diet, and exercise alone accounted
for close to 80 percent of all premature deaths and continue to lead in this way
through the 21st century.
[68]
Heart disease, stroke, dementia, and diabetes are
some of the diseases that may be affected by habit -forming patterns
throughout our life.
[68]
Some believe that medical lifestyle counseling and
building healthy habits around our daily lives is one way to tackle health care
reform.
[68]
Other cultures and healthcare
Buddhist medicine
Buddhist ethics and medicine are based on religious teachings of compassion
and understanding
[69]
of suffering and cause and effect and the idea that there
is no beginning or end to life, but that instead there are only rebirths in an
endless cycle.
[9]
In this way, death is merely a phase in an indefinitely lengthy
process of life, not an end. However, Buddhist teachings support living one's
life to the fullest so that through all the suffering which encompasses a large
part of what is life, there are no regrets. Buddhism accepts suffering as an
inescapable experience, but values happiness and thus values life.
[9]
Because
of this suicide, and euthanasia, are prohibited. However, attempts to rid
oneself of any physical or mental pain and suffering are seen as good acts. On
the other hand, sedatives and drugs are thought to impair consciousness and
awareness in the dying process, which is believed to be of great importance, as
it is thought that one's dying consciousness remains and affects new life.
Because of this, analgesics must not be part of the dying process, in order for
the dying person to be present entirely and pass on their consciousness
wholesomely. This can pose significant conflicts during end of life care in
Western medical practice.
[9]
Taoist symbol of Yin and Yang
Chinese medicine
In traditional Chinese philosophy, human life is believed to be connected to
nature, which is thought of as the foundation and encompassing force
sustaining all of life's phases.
[9]
Passing and coming of the seasons, life, birth
and death are perceived as a cyclic and perpetual occurrences that are believed
to be regulated by the principles of yin and yang.
[9]
When one dies, the life-
giving material force referred to as ch'i, encompassing both body and spirit,
rejoins the material force of the universe and cycles on with respect to the
rhythms set forth by yin and yang.
[9]
Because many Chinese pe ople believe that circulation of both physical and
'psychic energy' is important to stay healthy, procedures which require surgery,
as well as donations and transplantations of organs, are seen as a loss of ch'i,
resulting in the loss of someone's vital energy supporting their consciousness
and purpose in their lives. Furthermore, a person is never seen as a single unit
but rather as a source of relationship, interconnected in a social web.
[9]
Thus, it
is believed that what makes a human one of us is relatedness and
communication and family is seen as the basic unit of a community.
[9][15] This
can greatly affect the way medical decisions are made among family members,
as diagnoses are not always expected to be announced to the dying or sick, the
elderly are expected to be cared for and represented by their children and
physicians are expected to act in a paternalistic way.
[9][15] In short, informed
consent as well as patient privacy can be difficult to enforce when dealing with
Confucian families.
[9]
Furthermore, some Chinese people may be inclined to continue futile treatment
in order to extend life and allow for fulfillment of the practice of benevolence
and humanity.
[9]
In contrast, patients with strong Daoist beliefs may see death
as an obstacle and dying as a reunion with nature that should be accepted,
and are therefore less likely to ask for treatment of an irreversible condition.
[9]
Western medical practice.
[9]
Taoist symbol of Yin and Yang
Chinese medicine
In traditional Chinese philosophy, human life is believed to be connected to
nature, which is thought of as the foundation and encompassing force
sustaining all of life's phases.
[9]
Passing and coming of the seasons, life, birth
and death are perceived as a cyclic and perpetual occurrences that are believed
to be regulated by the principles of yin and yang.
[9]
When one dies, the life-
giving material force referred to as ch'i, encompassing both body and spirit,
rejoins the material force of the universe and cycles on with respect to the
rhythms set forth by yin and yang.
[9]
Because many Chinese pe ople believe that circulation of both physical and
'psychic energy' is important to stay healthy, procedures which require surgery,
as well as donations and transplantations of organs, are seen as a loss of ch'i,
resulting in the loss of someone's vital energy supporting their consciousness
and purpose in their lives. Furthermore, a person is never seen as a single unit
but rather as a source of relationship, interconnected in a social web.
[9]
Thus, it
is believed that what makes a human one of us is relatedness and
communication and family is seen as the basic unit of a community.
[9][15] This
can greatly affect the way medical decisions are made among family members,
as diagnoses are not always expected to be announced to the dying or sick, the
elderly are expected to be cared for and represented by their children and
physicians are expected to act in a paternalistic way.
[9][15] In short, informed
consent as well as patient privacy can be difficult to enforce when dealing with
Confucian families.
[9]
Furthermore, some Chinese people may be inclined to continue futile treatment
in order to extend life and allow for fulfillment of the practice of benevolence
and humanity.
[9]
In contrast, patients with strong Daoist beliefs may see death
as an obstacle and dying as a reunion with nature that should be accepted,
and are therefore less likely to ask for treatment of an irreversible condition.
[9]
Islamic culture and medicine
Some believe Islamic medical ethics and framework remain poorly understood
by many working in healthcare. It is important to recognize that for people of
Islamic faith, Islam envelops and affects all aspects of life, not just
medicine.
[70]
Because many believe it is faith and a supreme deity that hold the
cure to illness, it is common that the physician is viewed merely as help or
intermediary player during the process of healing or medical care.
[70]
In addition to Chinese culture's emphasis on family as the basic unit of a
community intertwined and forming a greater social construct, Islamic
traditional medicine also places importance on the values of family and the
well-being of a community.
[15][70]
Many Islamic communities uphold
paternalism as an acceptable part of medical care.
[70]
However, autonomy and
self-rule is also valued and protected and, in Islamic medicine, it is particularly
upheld in terms of providing and expecting privacy in the healthcare setting.
An example of this is requesting same gender providers in order to retain
modesty.
[70]
Overall, Beauchamp's principles of beneficence, non-maleficence
and justice
[1]
are promoted and upheld in the medical sphere with as much
importance as in Western culture.
[70]
In contrast, autonomy is important but
more nuanced. Furthermore, Islam also brings forth the principles of
jurisprudence, Islamic law and legal maxims, which also allow for Islam to
adapt to an ever-changing medical ethics framework.
[70]
Conflicts of interest
Physicians should not allow a conflict of interest to influence medical
judgment. In some cases, conflicts are hard to avoid, and doctors have a
responsibility to avoid entering such situations. Research has shown that
conflicts of interests are very common among both academic physicians
[71]
and
physicians in practice.
[72][73]
Referral
Doctors who receive income from referring patients for medical tests have been
shown to refer more patients for medical tests.
[74]
This practice is proscribed by
the American College of Physicians Ethics Manual.
[75]
Fee splitting and the
payments of commissions to attract referrals of patients is considered unethical
and unacceptable in most parts of the world.
[citation needed]
Vendor relationships
See also: Pharmaceutical marketing § To health care providers
Studies show that doctors can be influenced by drug company inducements,
including gifts and food.
[13]
Industry-sponsored Continuing Medical
Education (CME) programs influence prescribing patterns.
[76]
Many patients
surveyed in one study agreed that physician gifts from drug companies
influence prescribing practices.
[77]
A growing movement among physicians is
attempting to diminish the influence of pharmaceutical industry marketing
upon medical practice, as evidenced by Stanford University's ban on drug
Some believe Islamic medical ethics and framework remain poorly understood
by many working in healthcare. It is important to recognize that for people of
Islamic faith, Islam envelops and affects all aspects of life, not just
medicine.
[70]
Because many believe it is faith and a supreme deity that hold the
cure to illness, it is common that the physician is viewed merely as help or
intermediary player during the process of healing or medical care.
[70]
In addition to Chinese culture's emphasis on family as the basic unit of a
community intertwined and forming a greater social construct, Islamic
traditional medicine also places importance on the values of family and the
well-being of a community.
[15][70]
Many Islamic communities uphold
paternalism as an acceptable part of medical care.
[70]
However, autonomy and
self-rule is also valued and protected and, in Islamic medicine, it is particularly
upheld in terms of providing and expecting privacy in the healthcare setting.
An example of this is requesting same gender providers in order to retain
modesty.
[70]
Overall, Beauchamp's principles of beneficence, non-maleficence
and justice
[1]
are promoted and upheld in the medical sphere with as much
importance as in Western culture.
[70]
In contrast, autonomy is important but
more nuanced. Furthermore, Islam also brings forth the principles of
jurisprudence, Islamic law and legal maxims, which also allow for Islam to
adapt to an ever-changing medical ethics framework.
[70]
Conflicts of interest
Physicians should not allow a conflict of interest to influence medical
judgment. In some cases, conflicts are hard to avoid, and doctors have a
responsibility to avoid entering such situations. Research has shown that
conflicts of interests are very common among both academic physicians
[71]
and
physicians in practice.
[72][73]
Referral
Doctors who receive income from referring patients for medical tests have been
shown to refer more patients for medical tests.
[74]
This practice is proscribed by
the American College of Physicians Ethics Manual.
[75]
Fee splitting and the
payments of commissions to attract referrals of patients is considered unethical
and unacceptable in most parts of the world.
[citation needed]
Vendor relationships
See also: Pharmaceutical marketing § To health care providers
Studies show that doctors can be influenced by drug company inducements,
including gifts and food.
[13]
Industry-sponsored Continuing Medical
Education (CME) programs influence prescribing patterns.
[76]
Many patients
surveyed in one study agreed that physician gifts from drug companies
influence prescribing practices.
[77]
A growing movement among physicians is
attempting to diminish the influence of pharmaceutical industry marketing
upon medical practice, as evidenced by Stanford University's ban on drug
company-sponsored lunches and gifts. Other academic institutions that have
banned pharmaceutical industry-sponsored gifts and food include the Johns
Hopkins Medical Institutions, University of Michigan, Universit y of
Pennsylvania, and Yale University.
[78][79]
Treatment of family members
The American Medical Association (AMA) states that "Physicians generally
should not treat themselves or members of their immediate family".
[80]
This
code seeks to protect patients and physicians because professional objectivity
can be compromised when the physician is treating a loved one. Studies from
multiple health organizations have illustrated that physician-family member
relationships may cause an increase in diagnostic testing and costs.
[81]
Many
doctors still treat their family members. Doctors who do so must be vigilant not
to create conflicts of interest or treat inappropriately.
[82][83]
Physicians that treat
family members need to be conscious of conflicting expectations and dilemmas
when treating relatives, as established medical ethical principles may not be
morally imperative when family members are confronted with serious
illness.
[81][84]
Sexual relationships
Sexual relationships between doctors and patients can create ethical conflicts,
since sexual consent may conflict with the fiduciary responsibility of the
physician.
[85]
Out of the many disciplines in current medicine, there are studies
that have been conducted in order to ascertain the occurrence of Doctor -
Patient sexual misconduct. Results from those studies appear to indicate that
certain disciplines are more likely to be offenders than others. Psychiatrists
and obstetrician-gynecologists, for example, are two disciplines noted for
having a higher rate of sexual misconduct.
[86] The violation of ethical conduct
between doctors and patients also has an association with the age and sex of
doctor and patient. Male physicians aged 40 –49 and 50–59 years are two
groups that have been found to be more likely to have been reported for sexual
misconduct, while women aged 20 –39 have been found to make up a
significant portion of reported victims of sexual misconduct.
[87]
Doctors who
enter into sexual relationships with patients face the threats of losing
their medical license and prosecution. In the early 1990s, it was estimated that
2–9% of doctors had violated this rule.
[88]
Sexual relationships between
physicians and patients' relatives may also be prohibited in some jurisdictions,
although this prohibition is highly controversial.
[89]
Futility
Further information: Futile medical care
In some hospitals, medical futility is referred to as treatment that is unable to
benefit the patient.
[90]
An important part of practicing good medical ethics is by
attempting to avoid futility by practicing non-maleficence.
[90]
What should be
done if there is no chance that a patient will survive or benefit from a potential
banned pharmaceutical industry-sponsored gifts and food include the Johns
Hopkins Medical Institutions, University of Michigan, Universit y of
Pennsylvania, and Yale University.
[78][79]
Treatment of family members
The American Medical Association (AMA) states that "Physicians generally
should not treat themselves or members of their immediate family".
[80]
This
code seeks to protect patients and physicians because professional objectivity
can be compromised when the physician is treating a loved one. Studies from
multiple health organizations have illustrated that physician-family member
relationships may cause an increase in diagnostic testing and costs.
[81]
Many
doctors still treat their family members. Doctors who do so must be vigilant not
to create conflicts of interest or treat inappropriately.
[82][83]
Physicians that treat
family members need to be conscious of conflicting expectations and dilemmas
when treating relatives, as established medical ethical principles may not be
morally imperative when family members are confronted with serious
illness.
[81][84]
Sexual relationships
Sexual relationships between doctors and patients can create ethical conflicts,
since sexual consent may conflict with the fiduciary responsibility of the
physician.
[85]
Out of the many disciplines in current medicine, there are studies
that have been conducted in order to ascertain the occurrence of Doctor -
Patient sexual misconduct. Results from those studies appear to indicate that
certain disciplines are more likely to be offenders than others. Psychiatrists
and obstetrician-gynecologists, for example, are two disciplines noted for
having a higher rate of sexual misconduct.
[86] The violation of ethical conduct
between doctors and patients also has an association with the age and sex of
doctor and patient. Male physicians aged 40 –49 and 50–59 years are two
groups that have been found to be more likely to have been reported for sexual
misconduct, while women aged 20 –39 have been found to make up a
significant portion of reported victims of sexual misconduct.
[87]
Doctors who
enter into sexual relationships with patients face the threats of losing
their medical license and prosecution. In the early 1990s, it was estimated that
2–9% of doctors had violated this rule.
[88]
Sexual relationships between
physicians and patients' relatives may also be prohibited in some jurisdictions,
although this prohibition is highly controversial.
[89]
Futility
Further information: Futile medical care
In some hospitals, medical futility is referred to as treatment that is unable to
benefit the patient.
[90]
An important part of practicing good medical ethics is by
attempting to avoid futility by practicing non-maleficence.
[90]
What should be
done if there is no chance that a patient will survive or benefit from a potential
treatment but the family members insist on advanced care?
[90]
Previously, some
articles defined futility as the patient having less than a one percent chance of
surviving. Some of these cases are examined in court.
Advance directives include living wills and durable powers of attorney for
health care. (See also Do Not Resuscitate and cardiopulmonary resuscitation)
In many cases, the "expressed wishes" of the patient are documented in these
directives, and this provides a framework to guide family members and health
care professionals in the decision-making process when the patient is
incapacitated. Undocumented expressed wishes can also help guide decisions
in the absence of advance directives, as in the Quinlan case in Missouri.
"Substituted judgment" is the concept that a family member can give consent
for treatment if the patient is unable (or unwilling) to give consent themselves.
The key question for the decision-making surrogate is not, "What would you
like to do?", but instead, "What do you think the patient would want in this
situation?".
Courts have supported family's arbitrary definitions of futility to include simple
biological survival, as in the Baby K case (in which the courts ordered a child
born with only a brain stem instead of a complete brain to be kept on a
ventilator based on the religious belief that all life must be preserved).
Baby Doe Law establishes state protection for a disabled child's right to life,
ensuring that this right is protected even over the wishes of parents or
guardians in cases where they want to withhold treatment.
References
1. ^ Jump up to:
a
b
c
Beauchamp, J. (2013).
"Principles of Biomedical Ethics". Principles of
Biomedical Ethics. 7.
2. ^ Weise, Mary (2016). "Medical Ethics Made
Easy". Professional Case Management. 21 (2):
88–
94. doi:10.1097/ncm.0000000000000151 . PMID
26844716. S2CID 20134799.
3. ^ Jump up to:
a
b
"Bioethic Tools: Principles of
Bioethics". depts.washington.edu. Archived from
the original on 2017-05-10. Retrieved 2017-03-21.
4. ^ Jump up to:
a
b Berdine, Gilbert (2015-01-
10). "The Hippocratic Oath and Principles of
Medical Ethics". The Southwest Respiratory and
Critical Care Chronicles. 3 (9): 28–32–
32. doi:10.12746/swrccc.v3i9.185. ISSN 2325-
9205.
5. ^ Riddick, Frank (Spring 2003). "The Code of
Medical Ethics of the American Medical
[90]
Previously, some
articles defined futility as the patient having less than a one percent chance of
surviving. Some of these cases are examined in court.
Advance directives include living wills and durable powers of attorney for
health care. (See also Do Not Resuscitate and cardiopulmonary resuscitation)
In many cases, the "expressed wishes" of the patient are documented in these
directives, and this provides a framework to guide family members and health
care professionals in the decision-making process when the patient is
incapacitated. Undocumented expressed wishes can also help guide decisions
in the absence of advance directives, as in the Quinlan case in Missouri.
"Substituted judgment" is the concept that a family member can give consent
for treatment if the patient is unable (or unwilling) to give consent themselves.
The key question for the decision-making surrogate is not, "What would you
like to do?", but instead, "What do you think the patient would want in this
situation?".
Courts have supported family's arbitrary definitions of futility to include simple
biological survival, as in the Baby K case (in which the courts ordered a child
born with only a brain stem instead of a complete brain to be kept on a
ventilator based on the religious belief that all life must be preserved).
Baby Doe Law establishes state protection for a disabled child's right to life,
ensuring that this right is protected even over the wishes of parents or
guardians in cases where they want to withhold treatment.
References
1. ^ Jump up to:
a
b
c
Beauchamp, J. (2013).
"Principles of Biomedical Ethics". Principles of
Biomedical Ethics. 7.
2. ^ Weise, Mary (2016). "Medical Ethics Made
Easy". Professional Case Management. 21 (2):
88–
94. doi:10.1097/ncm.0000000000000151 . PMID
26844716. S2CID 20134799.
3. ^ Jump up to:
a
b
"Bioethic Tools: Principles of
Bioethics". depts.washington.edu. Archived from
the original on 2017-05-10. Retrieved 2017-03-21.
4. ^ Jump up to:
a
b Berdine, Gilbert (2015-01-
10). "The Hippocratic Oath and Principles of
Medical Ethics". The Southwest Respiratory and
Critical Care Chronicles. 3 (9): 28–32–
32. doi:10.12746/swrccc.v3i9.185. ISSN 2325-
9205.
5. ^ Riddick, Frank (Spring 2003). "The Code of
Medical Ethics of the American Medical
Association". The Ochsner Journal. 5 (2): 6–
10. PMC 3399321. PMID 22826677.
6. ^ "Safeguarding the future of human gen e
editing". login.proxylib.csueastbay.edu.
Retrieved 2019-03-19.
7. ^ Veit, Walter (2018). "Procreative Beneficence and
Genetic Enhancement". KRITERION – Journal of
Philosophy. 32 (11): 1 –
8. doi:10.13140/RG.2.2.11026.89289.
8. ^ Veit, Walter; Anomaly, Jonathan; Agar, Nicholas;
Singer, Peter; Fleischman, Diana; Minerva,
Francesca (2021). "Can 'eugenics' be
defended?". Monash Bioethics Review. 39(1): 60–
67. doi:10.1007/s40592-021-00129-
1. PMC 8321981. PMID 34033008.
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Coward,
Harold G. (1999). A Cross-Cultural Dialogue on
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Wilfrid Laurier university Press. pp. 119–
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A. Brow, Julie (June 2002).
"When culture and medicine collide". The Dental
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Appel, JM. Must My Doctor Tell
My Partner? Rethinking Confidentiality In the HIV
Era, Medicine and Health Rhode Island, Jun 2006
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Prah Ruger, Jennifer
(October 2014). "Good medical ethics, justice and
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Güldal D, Semin S (2000). "The
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14. ^ "Medicine Interview Hot Topics:
Confidentiality". BlackStone Tutors | Medicine
Application Specialists.
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December 2006). "Doctor–patient sexual
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41. PMID 17145909.
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patient relationship turns sexual" . Canadian
Medical Association Journal. 188 (4): 247–
248. doi:10.1503/cmaj.109-
5230. PMC 4771530. PMID 26858353.
87. ^ AbuDagga, Wolfe, Carome, Oshel, Azza,
Sidney, Michael, Robert (February 2016). "Cross-
Sectional Analysis of the 1039 U.S. Physicians
Reported to the National Practitioner Data Bank for
Sexual Misconduct, 2003 –2013". PLOS
ONE. 11 (2):
e0147800. Bibcode:2016PLoSO..1147800A. doi:1
0.1371/journal.pone.0147800. PMC 4739584. P
MID 26840639.
88. ^ Gartrell N, Milliken N, Goodson W, Thiemann S,
Lo B (1992). "Physician-patient sexual contact.
Prevalence and problems". West J Med. 157 (2):
139–43. PMC 1011231. PMID 1441462.
89. ^ JM Appel. May Physicians Date Their Patients’
Relatives? Rethinking Sexual Misconduct &
Disclosure After Long v. Ostroff, Medicine &
Health, Rhode Island, May 2004
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b
c
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Oxford University Press.
Bioethics introduction at the Wayback
Machine (archived 2007-07-03)
Brody, Baruch A. 1988. Life and Death Decision
Making. New York: Oxford University Press.
Curran, Charles E. "The Catholic Moral Tradition in
Bioethics" in Walter and Klein (below).
Epstein, Steven (2009). Inclusion: The Politics of
Difference in Medical Research. University of Chicago
Press. ISBN 978-0-226-21310-1.
Fletcher, Joseph Francis (1954). Morals and
Medicine: The Moral Problems of: The Patient's Right to
Know the Truth, Contraception, Artificial Insemination,
Sterilization, Euthanasia. Boston: Beacon.
Hastings Center (1984). The Hastings Center's
Bibliography of Ethics, Biomedicine, and Professional
Responsibility. OCLC 10727310.
Kelly, David (1979). The Emergence of Roman
Catholic Medical Ethics in North America. New York:
The Edwin Mellen Press. See especially chapter 1,
"Historical background to the discipline."
Sherwin, Susan (1992). No Longer Patient: Feminist
Ethics and Health Care . Philadelphia: Temple
University Press. OCLC 23654449.
Veatch, Robert M. (1988). A Theory of Medical Ethics.
New York: Basic Books. OCLC 7739374.
Walter, Jennifer; Eran P. Klein, eds. (2003). The story
of bioethics: from seminal works to contemporary
explorations. Georgetown University
Press. OCLC 51810892.
Tauber, Alfred I. (1999). Confessions of a Medicine
Man. Cambridge: MIT Press. OCLC 42328600.
Tauber, Alfred I. (2005). Patient autonomy and the
ethics of responsibility. Cambridge: MIT
Press. OCLC 59003635.
100990. JSTOR 43282683. PMID 23355225. S2
CID 42035179.
Sources[edit]
Beauchamp, Tom L., and Childress, James F.
2001. Principles of Biomedical Ethics. New York:
Oxford University Press.
Bioethics introduction at the Wayback
Machine (archived 2007-07-03)
Brody, Baruch A. 1988. Life and Death Decision
Making. New York: Oxford University Press.
Curran, Charles E. "The Catholic Moral Tradition in
Bioethics" in Walter and Klein (below).
Epstein, Steven (2009). Inclusion: The Politics of
Difference in Medical Research. University of Chicago
Press. ISBN 978-0-226-21310-1.
Fletcher, Joseph Francis (1954). Morals and
Medicine: The Moral Problems of: The Patient's Right to
Know the Truth, Contraception, Artificial Insemination,
Sterilization, Euthanasia. Boston: Beacon.
Hastings Center (1984). The Hastings Center's
Bibliography of Ethics, Biomedicine, and Professional
Responsibility. OCLC 10727310.
Kelly, David (1979). The Emergence of Roman
Catholic Medical Ethics in North America. New York:
The Edwin Mellen Press. See especially chapter 1,
"Historical background to the discipline."
Sherwin, Susan (1992). No Longer Patient: Feminist
Ethics and Health Care . Philadelphia: Temple
University Press. OCLC 23654449.
Veatch, Robert M. (1988). A Theory of Medical Ethics.
New York: Basic Books. OCLC 7739374.
Walter, Jennifer; Eran P. Klein, eds. (2003). The story
of bioethics: from seminal works to contemporary
explorations. Georgetown University
Press. OCLC 51810892.
Tauber, Alfred I. (1999). Confessions of a Medicine
Man. Cambridge: MIT Press. OCLC 42328600.
Tauber, Alfred I. (2005). Patient autonomy and the
ethics of responsibility. Cambridge: MIT
Press. OCLC 59003635.
«Législation, éthique et déontologie», Bruxelles:
Editions de Boeck Université, 2011, Karine
BREHAUX, ISBN 978-2-84371-558-7.
External links[edit]
Bioethics at Curlie
Global health ethics at World Health Organization
Health Care Ethics article in the Internet
Encyclopedia of Philosophy
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v
t
e
Bioethics
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v
t
e
Research participant rights
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v
t
e
Medical ethics cases
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v
t
e
Ethics
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Authority control
Categories:
Medical ethics
Navigation menu
Editions de Boeck Université, 2011, Karine
BREHAUX, ISBN 978-2-84371-558-7.
External links[edit]
Bioethics at Curlie
Global health ethics at World Health Organization
Health Care Ethics article in the Internet
Encyclopedia of Philosophy
show
v
t
e
Bioethics
show
v
t
e
Research participant rights
show
v
t
e
Medical ethics cases
show
v
t
e
Ethics
show
Authority control
Categories:
Medical ethics
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