Medical Ethics

By Shauna O’Sullivan

Outline

• Background

• Definition of Medical Ethics

• Ethical Guideline

• Principles of Medical Ethics

Background

• Medical professionals increasingly find themselves

confronted with moral questions and ethical

dilemmas

• Need to reflect on the moral dimension led to a

number of international ethical codes and guidelines

Background

• Documents present a set of basic principles for

medical ethics that are deemed universally valid by

interested bodies

• Many countries have established their own national

medical ruling bodies to govern ethical issues that

arise within their medical communities

Overview of Medical Ethics

• Medical profession has maintained simple medical

ethics standards for more than 4,000 years

– Hippocratic Oath, Prayer of Moses Maimonides, Bible,

Holy Koran, as well as cultures, traditions and social

mortality have shaped ethical standards

• Majority of these documents focus on “avoiding harm

to patients”

Definition of Medical Ethics

• A system of moral principles that apply values and

judgments to the practice of medicine

• “Ethics is the moral reasoning of actions”

– Morality refers to social norms that distinguish between

right and wrong in human conduct

• Ethics refers to a professional moral conduct

– Moral actions based on professional character and

ethical principles in each profession

Medical Ethics

• Medical professionals must confront ethical

dilemmas on a consistent basis

• Ethical dilemmas are not rare phenomena and thus

merit special attention

Medical Ethics

• Do the best for the patient and place the patient’s

interests before the interests of the physician

• Purpose is to protect and defend human dignity and

patient’s rights

• It is not about avoiding harm; rather, it is a set of

norms, values and principles

Ethical Guidelines

• International guidelines such as the Declaration of Geneva

(1948) proclaim that medical care must not violate any

universally applicable standards

• Help medical and professional professionals around the world

to:

– Recognize ethical dilemmas in medical and health care

– Provide general rules and principles to guide decision making

processes during these dilemmas

Ethical Guidelines

• Ethics is culturally defined

• Applied ethics involves cultures and traditions

– Relies on academia to inform the profession of ethical

theories and principles

• International guidelines acknowledge the need to

account for cultural values and traditions

Why is it important to adhere to ethical standards in medical care?

• Promotes the aim of medical care: to alleviate

suffering

• Built on communication between medical providers

and patient’s or patient’s families

• Helps build support for medical care

Ethical Principles

• In the realm of health care, it is difficult to hold rules

or principles that are absolute

– Even thought they are not absolute they serve as powerful

action guides in clinical medicine

• For medical practice to be considered “ethical”

– It must respect all 4 of these principles: autonomy, non-

maleficence, beneficence and justice

Autonomy

• The right of patients to make decisions about their

medical care without their health care provider

trying to influence the decision

• Patient autonomy does allow for health care

providers to educate the patient but does not allow

the health care provider to make the decision for the

patient

Autonomy

• Respect for autonomy is one of the fundamental

guidelines of medical ethics

• Autonomy in medicine is not simply allowing patients

to make their own decisions

• Physicians have an obligation to create the conditions

necessary for autonomous choice in others

Autonomy

• For a physician, respect for autonomy includes

respecting an individual’s right to self-determination

as well as creating the conditions necessary for

autonomous choice

• This principle is the basis of “informed consent”

Informed Consent

• Informed consent is more than simply getting a

patient to sign a written consent form

• Process of communication between a patient and

physician that results in the patient’s agreement to

undergo a specific medical intervention

Informed Consent

• Communication process must involve:

– Patient's diagnosis, if known;

– Nature and purpose of a proposed treatment

– Risks and benefits of a proposed treatment

– Alternatives to the treatment

– Risks and benefits of the alternative treatment

– Risks and benefits of not receiving treatment

Autonomy

• Includes confidentiality, seeking consent for medical

treatment and procedures, disclosing information about

their medical condition to patients, and maintaining

privacy

• Illustrative case: Jehovah’s Witnesses have a belief that

it is wrong to accept a blood transfusion

– What happens if a blood transfusion is needed to save a

person’s life?

Non-maleficence

• “Do no harm ”

• Physicians must refrain from providing ineffective

treatments or acting with malice toward patients

• This principle is difficult as many beneficial

therapies also have serious risks

– The pertinent ethical issue is whether the benefits

outweigh the burdens

Non-maleficence

• Considered negligence if one imposes a

careless or unreasonable risk of harm to

another

• Providing a proper standard of care

– Avoids or minimizes the risk of harm is supported

by moral convictions but laws of society as well

Non-maleficence

• This principle affirms the need for medical

competence

– It is clear that medical mistakes occur

– This principle articulates a fundamental

commitment on the part of medical professionals

to protect their patients from harm

Non-maleficence

• Illustrative case: How to best treat a pregnant

women with newly diagnosed uterine cancer

– A single action may have 2 effects, one that is considered

good and the other bad (Principle of double effect)

– What do you think about this case? What is right and

what is wrong?

Beneficence

• Duty of the health care provider to be of benefit to the patient

– Take positive steps to prevent and to remove harm from the

patient

• These duties are viewed as self-evident and viewed as the

proper goals of medicine

• These goals are applied to both the patient, and to the good of

society as a whole

– Vaccinations for disease prevention example

Beneficence

• Illustrative case: One clear example exists in health care where

principle of beneficence is given priority over the principle of

respect of autonomy

• Example is in the Emergency Room: Patient is incapacitated by

the grave nature of accident or illness

– We presume that the reasonable person would want to be

treated aggressively and we rush to provide beneficent

intervention

Autonomy vs. Beneficence

• Often the most common and difficult ethical issues to

navigate arise when the patient’s autonomous decision

conflicts with the physician’s beneficent duty

– Should a patient who has had heart bypass surgery

continue to smoke?

– What would you do if a patient with pneumonia refuses

antibiotics?

Justice

• Justice in health care is usually defined as a form of

fairness, or as Aristotle once said, "giving to each

that which is his due“

• Deals with issues of treating patients equally

• Physicians should treat similarly situated patients

similarly and allocate resources justly

Justice

• If you had ten patients and only enough medicine to

save five, who would you give the medication to

first?

Summary

• Medical professionals increasingly find themselves

confronted with moral questions and ethical dilemmas

• Ethics refers to a professional moral conduct

• For medical practice to be considered “ethical”

– It must respect all 4 of these principles: autonomy,

non- maleficence, beneficence and justice

Any Questions?

References

• www.ama-assn.org (AMA code of ethics)

• http://depts.washington.edu (Ethics in Medicine)

• Gillon R. Medical Ethics: four principles plus

attention to scope. BMJ. 1994 Jul 16;

309(6948):184-8.