Medical ethics Introduction to basic principles

Ethics are not …
Ethics is not the same as feelings
Ethics is not religion
Ethics is not following the law
Ethics is not following culturally accepted norms
Ethics is not science

Ethics are …
Moral Principles
What is good and bad
What is right and wrong
Based on value system
Ethical norms are not universal – depends on the sub culture of the society

ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves
as friends, parents, children, citizens, businesspeople, teachers, professionals, and so on.

Historically
medical ethics may be traced to guidelines on the duty of physicians such as the Hippocratic oath

a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. These are not laws, but standards of conduct which define the essentials of honorable behavior for the physician

Four basic Principles of Medical Ethics
Autonomy
Beneficence
Non maleficience
Justice

Autonomy
Patient has freedom of thought, intention and action when making decisions regarding health care procedures
For a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.

Always respect the autonomy of the patient - then the particular patient is free to choose
Such respect is not simply a matter of attitude, but a way of acting so as to recognize and even promote the autonomous actions of the patient.
The autonomous person may freely choose loyalties or systems of religious belief that may adversely affect him

The patient must be informed clearly the consequences of his action that may affect him adversely.
Desiring to "benefit" the patient, the physician may strongly want to intervene believing it to be a clear "medical benefit." The physician has a duty to respect the autonomous choice of the patient, as well as a duty to avoid harm and to provide a medical benefit.

But the physician should give greater priority to the respect for patient autonomy than to the other duties.
However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals.

In the case of a child, the principle of avoiding the harm of death, and the principle of providing a medical benefit that can restore the child to health and life, would be given precedence over the autonomy of the child's parents as surrogate decision makers.

Beneficence
The practitioner should act in “the best interest” of the patient - the procedure be provided with the intent of doing good to the patient

This needs health care provider to,
- develop and maintain skills and knowledge by continually updating training
- consider individual circumstances of all patients

Non maleficence
“Above all, do no harm,“ – Make sure that the procedure does not harm the patient or others in society

When interventions undertaken by physicians create a positive outcome while also potentially doing harm it is known as the "double effect."
Eg,. the use of morphine in the dying patient. eases pain and suffering while hastening the demise through suppression of the respiratory drive

Physicians are obligated not prescribe medications they know to be harmful.
Some interpret this value to exclude the practice of euthanasia
Violation of non-maleficence is the subject of medical malpractice litigation

Medical malpractice
An act or omission by a health care provider that deviates from accepted standards of practice in the medical community which causes injury to the patient.

Justice
The distribution of scarce health resources, and the decision of who gets what treatment “fairness and equality”
The burdens and benefits of new or experimental treatments must be distributed equally among all groups in society