Medical ethics

Medical ethics is the discipline of evaluating the merits, risks, and social concerns of activities in the field of medicine.

Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics.

Ethical thinkers have suggested many methods to help evaluate the ethics of a situation. These methods provide principles that doctors should consider while making decisions.

Six of the principles commonly included are:

• Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
• Non-maleficence - "first, do no harm" (primum non nocere).
• Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
• Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment.
• Dignity - the patient (and the person treating the patient) have the right to dignity.
• Truthfulness and honesty - the patient should not be lied to, and deserves to know the whole truth about his/her illness and treatment.

Principles such as these do not give answers as to how to handle a particular situation, but guide doctors on what principles ought to apply to actual circumstances. The principles sometimes contradict each other leading to ethical dilemmas. For example, the principles of autonomy and beneficence clash when patients refuse life-saving blood transfusion, and truthfulness may not always be upheld regarding the use of placebos in some instances.

To reconcile conflicting principles, Bernard Gert, a philosopher who specializes in medical ethics, propounds a theory that would require us to advocate our action publicly if we were to violate any basic moral principles (e.g., break a promise in order to save a life). Other philosophers, such as R. M. Hare, would require us to formulate a universal prescription in conformance with logic, such that all rational parties, including the patient (assuming he is rational), would subscribe to the same action in all circumstances that share the same essential properties.

In the United Kingdom, General Medical Council provides clear modern guidance in the form of its 'Good Medical Practice' statement.

Beneficence

Inevitably, beneficence is judged by the physician as biased by his own experiences and beliefs. The definition of "best interests of the patient" also changes over time. The definition of beneficence, so far, has remained the prerogative of physicians as protected by the American Judiciary branch of government, though the Legislative and Executive branches of the U.S. Government attempted to insert themselves into the discussion of beneficence in the Terry Schiavo case.

Common medical ethical dilemmas

Conflicts-of-interest

One aspect to beneficence is that the physician should not allow a conflict-of-interest to influence medical judgment. For example, doctors who receive income from referring patients to medical tests have been shown to refer more patients for medical tests . This practice is proscribed by the American College of Physicians Ethics Manual .

Sexual relationships

Sexual relationships between doctors and patients have been discouraged since the Hippocratic Oath, which states, "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves." This has traditionally been taken to mean that sexual relationships between doctors and patients are to be avoided. Doctors who violate this rule face the threats of deregistration and prosecution. It is estimated that between 2% and 9% of doctors have violated this rule based on a study in the early 1990s . One pundit declares to physicians, "You can make your mistress your patient, but you cannot make your patient your mistress."

Treatment of family members

Increasingly, it is seen as inappropriate for doctors to treat members of their own family (partners, parents, children, etc.). The reasons given for this is that the patient may not be able to be open and honest about their condition, given the family relationship, and that the family relationship may be used to pressure the patient in to agree to treatment they might otherwise have not, thus interfering with their autonomy. On the other hand, however, patients with a doctor in their family may prefer to seek treatment from them, due to the greater trust they have in them, the greater convenience they represent, and in some cases their ability to use the family relationship to pressure or manipulate the physician into providing treatment they might otherwise see as inappropriate in the patient's circumstances (e.g. appetite suppressants, drugs of addiction). In the past this behavior has not always been seen so negatively by the profession, and it still sometimes continues.

Reproductive medicine

• Accessibility of abortion
• Bioethics of neonatal circumcision
• Cloning
• Eugenics
• Genetic manipulation

Medical research

• Animal research
• Belmont Report stated three ethical principles (1978):

Respect for persons, including informed consent.

Beneficence

Justice

• CIOMS Guidelines
• Common rules. Adopted by 17 United States departments and agencies (1991).
• Declaration of Geneva
• Declaration of Helsinki
• Declaration of Tokyo
• Good Clinical Practice (FDA)
• Human experimentation
• Illegal Medical Experiments and the United States Government
• Nuremberg Code
• Privacy. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule
• Patients' Bill of Rights
• Stem cell research
• Universal Declaration of Human Rights
• Willowbrook Study
• Tuskegee Study

Distribution and utilization of research and care

• Accessibility of health care
• Basis of priority for organ transplantation
• Institutionalization of care access through HMOs and medical insurance companies

External links

• Hippocratic Oath - Classical version
• Hippocratic Oath - Modern version
• Physician's Oath - Declaration of Geneva (1948)
• World Medical Assocation (WMA)
• Nuremberg Code - ethical code
• Declaration of Geneva - ethical code
• Declaration of Helsinki - ethical code
• BMJJournals.com
  • Medical ethics: four principles plus attention to scope BMJ (1994) 309:184 (16 July)
  • Journal of Medical Ethics - An international peer review journal for health professionals and researchers in medical ethics
• The HastingsCenter.org - 'The Hastings Center: Leading Bioethics into the Future'
• UChicago.edu - MacLean Center for Clinical Medical Ethics, University of Chicago Department of Medicine
• Washington.edu - 'Ethics in Medicine: Bioethics Topics', University of Washington School of Medicine
• bioethics.lumc.edu - Neiswanger Institute for Bioethics & Health Policy, Loyola University Chicago Stritch School of Medicine