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 MEDICAL ETHICS

ETHICS

1
The English word "ethics" is derived from the Ancient Greek word ēthikós (ἠθικός), meaning
"relating to one's character".

DEFINITION
2 Moral principles that govern a person’s behavior or the conducting of an activity. Or we can
say that 3The basic concepts and fundamental principles of decent human conduct. It includes
study of universal values such as the essential equality of all men and women, human or natural
rights, obedience to the law of land, concern for health and safety and, increasingly, also for the
natural environment.
1
Ethics or Moral philosophy is a branch of philosophy that involves systematizing, defending, and
recommending concepts of right and wrong conducts. 4The field of ethics, along with aesthetics,
concern matters of values, and thus comprise the branch of philosophy called axiology.
5
1Ethics is concerned with moral principles, values and standards of conduct (WHO).
2. Ethics is the study of morality careful and systemic reflection on and analyses of moral decisions
and behavior.
3. Morality is the value dimension of human decision making and behavior.
Ethics is a very large and complex field of study with many branches or subdivision.
Medical ethics is a branch of ethics that deals with moral issues in medical practice.

MEDICAL ETHICS
6
It is a system of moral principles that apply values to the practice of clinical medicine and in
scientific research. Medical ethics is based on a set of values that professionals can refer to in the
case of any confusion or conflict.

 7
Medical ethics is primarily a field of applied ethics,the study of moral values and
judgments as they apply to medicine
 As a scholarly discipline,medical ethics encompasses its practical application in clinical
settings as well as work on its history,philosophy,theology and sociology.

Medical ethics tends to be umderstood narrowly as an applied professional ethics, where as

bioethics appears to have worked more expensive concerns,touching upon the philosophy of
science and issues of biotechnology.
8Medical ethics is a system of moral principles that apply values to the practice of clinical

medicine and in 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,

1
non-maleficence, beneficence and justice .9these may allow doctors, care providers, and families
to create a treatment plan and work towards the same common goal without any conflict.
There are several other codes of conduct.
6
1)The Hippocratic Oath discusses basic principles for medical professionals. This document
dates back to the fifth century BCE.
2)Both The Declaration of Helsinki (1964) and The Nuremberg Code (1947) are two well-
known and well respected documents contributing to medical ethics.
VALUES
A common framework used in the analysis of medical ethics is the "four principles" approach
postulated by Tom Beauchamp and James Childress in their textbook Principles of biomedical
ethics.
The four basic principles are
1)Autonomy
2)Benefecence
3) Non-maleficence
4) Justice.
Other values are sometime discussed are
 Respect for person
 Truthfulness and honesty
7AUTONOMY

“ The definition of autonomy is the ability of an individual to make a

rational, un-influenced decision.”
The patient has the right to refuse or choose their treatment.
 The principle of autonomy views the rights of an individual to self-determination.
 This is rooted in society's respect for individuals' ability to make informed decisions about
personal matters with freedom. it can be said that autonomy is a general indicator of a
healthy mind and body.
 Therefore the progression of many terminal diseases are characterized by loss of autonomy,
in various manners and extents. For example, dementia almost always results in the loss of
autonomy.
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.
10
RESPECT FOR AUTONOMY
Any notion of moral decision-making assumes that rational agents are involved in making
informed and voluntary decisions. In health care decisions, our respect for the autonomy of the
patient would, in common parlance, imply that the patient has the capacity to act intentionally,
with understanding, and without controlling influences that would mitigate against a free and
voluntary act. This principle is the basis for the practice of "informed consent" in the
physician/patient transaction regarding health care.
FOR EXAMPLE
“ Jehovah's Witnesses have a belief that it is wrong to accept a blood transfusion.
Therefore, in a life-threatening situation where a blood transfusion is required to save the
life of the patient, the patient must be so informed. The consequences of refusing a blood
transfusion must be made clear to the patient at risk of dying from blood loss. Desiring to
"benefit" the patient, the physician may strongly want to provide a blood transfusion,

2
believing it to be a clear "medical benefit." When properly and compassionately informed,
the particular patient is then free to choosewhether to accept the blood transfusion in keeping
with a strong desire to live, or whether to refuse the blood transfusion in giving a greater
priority to his or her religious convictions about the wrongness of blood transfusions, even
to the point of accepting death as a predictable outcome. This communication process must
be compassionate and respectful of the patient’s unique values, even if they differ from the
standard goals of biomedicine.’’
BENEFICENCE
6
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.
However, uncertainty surrounds the precise definition of which practices do in fact help patients.
10
The ordinary meaning of this principle is that health care providers have a duty to be of a benefit
to the patient, as well as to take positive steps to prevent and to remove harm from the patient These
duties are viewed as rational and self-evident and are widely accepted as the proper goals of
medicine. This principle is at the very heart of health care implying that a suffering supplicant
(the patient) can enter into a relationship with one whom society has licensed as competent to
provide medical care, trusting that the physician’s chief objective is to help . The goal of providing
benefit can be applied both to individual patients, and to the good of society as a whole. For
example, the good health of a particular patient is an appropriate goal of medicine, and the
prevention of disease through research and the employment of vaccines is the same goal expanded
to the population at large.

NON-MALEFICENCE

The principle of non-maleficence requires of us that we not intentionally create a harm or injury
to the patient, either through acts of commission or omission. Providing a proper standard of care
that avoids or minimizes the risk of harm is supported not only by our commonly held moral
convictions, but by the laws of society as well (see Law and Medical Ethics). This principle affirms
the need for medical competence. It is clear that medical mistakes may occur; however, this
principle articulates a fundamental commitment on the part of health care professionals to protect
their patients from harm

For example, most would be willing to experience some pain if the

procedure in question would prolong life. However, in other cases, such as the case of a
patient dying of painful intestinal carcinoma, the patient might choose to forego CPR in
the event of a cardiac or respiratory arrest, or the patient might choose to forego life-
sustaining technology such as dialysis or a respirator. The reason for such a choice is
based on the belief of the patient that prolonged living with a painful and debilitating
condition is worse than death, a greater harm. It is also important to note in this case
that this determination was made by the patient, who alone is the authority on the
interpretation of the "greater" or "lesser" harm for the self.

JUSTICE:

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concerns the distribution of scarce health resources, and the decision of who gets what treatment
(fairness and equality)
Justice in health care is usually defined as a form of fairness. the fair dis It is generally held that
persons who are equals should qualify for equal treatment Distribution of goods in society and
requires that we look at the role of entitlement.
In fact, our society uses a variety of factors as criteria for distributive justice, including the
following:
1. To each person an equal share.
2. To each person according to need.
3. To each person according to effort.
4. To each person according to contribution.
5. To each person according to merit.
6INFORMED CONSENT

is a process for getting permission before conducting a healthcare intervention on a person, or

for disclosing personal information. A health care provider may ask a patient to consent to
receive therapy before providing it, or a clinical researcher may ask a research
participant before enrolling that person into a clinical trial Informed consent is collected
according to guidelines from the fields of medical ethics and research ethics.

Confidentiality

Confidentiality is commonly applied to conversations between doctors and patients. 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 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.

Importance of communication
Many so-called "ethical conflicts" in medical ethics are traceable back to a lack
of communication. Communication breakdowns between patients and their healthcare
team, between family members, or between members of the medical community, can all
lead to disagreements and strong feelings. These breakdowns should be remedied, and
many apparently insurmountable "ethics" problems can be solved with open lines of
communication. Medical Ethics Problems Can Be Challenging
11WHY MEDICAL ETHICS IS IMPORTANT IN MEDICAL PROFESSION.

Medical ethics involves examining a specific problem, usually a clinical case, and using
values, facts, and logic to decide what the best course of action should be.
Some ethical problems are fairly straightforward, such as determining right from wrong.
But others can also be more perplexing, such as deciding between two "rights"—two values
that are in conflict with each other—or deciding between two different value systems, such
as the patient's versus the doctor's.
Doctors may deal with a great variety of perplexing ethical problems even in a small
medical practice. Here are some common problems identified in a 2016 Medscape survey,
where at least some physicians held different opinions

4
  Withholding treatment to meet an organization's budget, or because of insurance policies;
 Accepting money from pharmaceutical or device manufacturers;
 Upcoding to get treatment covered;
 Getting romantically involved with a patient or family member;
 Covering up a mistake;
 Reporting an impaired colleague;
 Cherry-picking patients;
 Prescribing a placebo;
 Practicing defensive medicine to avoid malpractice lawsuits;
 Dropping insurers; and
 Breaching patient confidentiality owing to a health risk.
Professional standards are a way to provide some guidance on ethical problems, but they
cannot address every issue, and they may not address troubling nuances, such as
reconciling two conflicting values.
Here are some reasons to take medical ethics seriously:
 To help resolve disputes between family, patients, physicians, or other parties. Often,
the parties involved are operating strictly on emotion, which makes it difficult to come to
a logical and fair decision. Ethics adds another dimension to help make decisions.
 To maintain a clear conscience. All doctors want to be sure they have done the right thing.
Being an ethical physician is more important than making money or seeing as many
patients as possible.
 To not make yourself look uninformed. Physicians sometimes stumble onto poor
decisions because they did not understand their role, had not bothered to identify an ethical
challenge, or hadn't thought the situation through to its logical conclusion.
 To maintain the respect of your patients. Ethical missteps can destroy the bond between
doctor and patient. Patients often implicitly trust their doctors, but once that trust has been
breached, it is difficult to repair.
 To maintain respectful relationships with other clinicians. Your colleagues often have
very definite opinions about what is ethical, often enshrined in various codes of ethics of
the profession or learned from mentors. Those codes and ethics role-modeling are created
by people who practice some form of ethical decision-making.
 To maintain some efficiency. Although ethical decision-making often requires extra time,
it also can save time by anticipating disagreements that can slow down the care process. If
you aren't ethical, patients or other caregivers who are upset with your decisions can
seriously impede your work.
 To reduce burnout. One cause of burnout is incongruence between physicians' personal
values and those of their organization. Physicians who can describe their ethical concerns
and use negotiating skills may be able to change the organizational policies that produce
burnout.

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 REFERENCE
1. An Intermediate Greek-English Lexicon. 1889.

2.https://en.oxforddictionaries.com/definition/ethics

3. http://www.businessdictionary.com/definition/ethics.html

4. Random House Unabridged Dictionary

5. https://www.slideshare.net/drbharatpaul/medical-ethics-48927587

6. https://en.wikipedia.org/wiki/Medical_ethics

7. https://www.slideshare.net/donwlewis/medical-ethics-64974300

8. Beauchamp, J. (2013). "Principles of Biomedical Ethics". Principles of Biomedical Ethics.

9. Weise, Mary (2016). "Medical Ethics Made Easy". Professional Case Management.

10.https://depts.washington.edu/bioethx/tools/princpl.html

11. https://www.medscape.com/courses/section/898060