BY
Andy Yoder
November 5, 2007
Thesis:
Medical ethics as applied to practical applications in clinical settings is a
major concern of today’s healthcare system.
I.
Introduction
A. Definition of medical ethics
B. Broad overview of medical ethics as applied to
medicine today
C. Broad overview of the content of the paper
II.
History
A. Autonomy
B. Justice
C. Dignity
D. Honesty
E. Beneficence
VII.
Futile medical care
VIII.
Conclusion
IX. References
Medical ethics are an important
guideline for those who are working in the field of healthcare. This is
especially true today due to the rapid increase of new technology that has
given clinical researchers new insights into cloning, the use of stem cells and
new ways of treating cancer. The Hippocratic Oath is a relevant guide for
physicians who are working with patients in making sure that they minimize the
harm and increase the benefit of their patients. The struggle that physicians
face is the constant battle between trying to apply the Hippocratic Oath which
is timeless while medical practice continues to make forward progress (Ethics
manual, 1998). Some of the factors that have caused physicians to move away
from the ethical values include, emphasis on effectiveness and efficiency,
patients having more power, and the government pressuring the medical schools in
the accreditation processes (Rancich et., Al. 2005).
The American Medical Association has
provided principles of medical ethics by which all doctors are required to
practice. These principles are not laws, but standards that describe the
behavior of an honorable and trustworthy physician (Edge and Groves, 2005). The
main focus of these principles is to benefit the patient. Physicians are called
to treat patients with dignity and respect while providing great medical care.
The best interest of the patient should always be the main concern of all
physicians. In this paper I will attempt to give insight into how physicians
can practice moral values and applied ethics in clinical settings of today’s
healthcare system by looking at both current and past ethical concepts.
The term medical ethics as used in
western society can be traced back to the Hippocratic Oath which is believed to
have been written in the 4th century BC by Hippocrates (Wikipedia: Medical
Ethics, 2007). Christian teachings have also had a great influence in laying
the foundation for the moral values that are used by doctors today. The
document known as the Hippocratic Oath was historically written as a guide for
practitioners and was required to be taken by oath. However, over the years the
medical schools and physicians have moved further and further from the
Hippocratic Oath and have moved more into the direction of using moral
judgments as their guide in clinical practice.
In the 1970’s
the field of bioethics and the U.S. President’s Commission began making its
impact in healthcare and research (Ethics manual, 1998). This was very
important both then and now in that it presented opportunities for discussion
on such issues as genetic screening and physician-patient relationships. The
medical ethics and moral values of the present day U.S. healthcare system are
of major concern as many of its citizens do not have access to healthcare. For
example, when debating the current healthcare system physicians use medical
ethics as a guideline for determining whether healthcare should be considered a
right or a privilege. Managed care is another aspect of the U.S. healthcare
system that continues to grow which has presented physicians with dilemmas in
patient treatment. For example, the managed care system often lowers the
quality of care given to patients since it regulates the pay of physicians and
their clinical judgment (McCullough, 1999). The clinical judgment of the
physician is regulated by the managed care system in that they often times
determine the type of treatment used. This then causes conflicts of interest
upon the physician which ultimately can affect the patient. In essence, today
more than ever medical ethics are of great value in guiding policy makers in
making the right decisions for the future of healthcare worldwide.
Autonomy
Autonomy is important in clinical
practice because it gives the patient the right to make decisions concerning
his/her clinical care. This can cause conflicts between the physician and the
patient due to differing opinions on how a disease should be treated. The
dilemma that doctors face in the use of patient autonomy is that they are in
many cases not allowed to treat patients even when they believe a cure for the
disease is possible. Autonomy is popular today because the social values of
society “define medical quality in terms of outcomes that are important to the
patient rather than medical professionals” (Ethics manual, 1998). Physicians
must therefore be able to communicate to the patients the pros and cons of the
possible treatments available for them in a way that is understandable by an
uneducated adult. In essence, when practicing autonomy the best interest of the
patient is only met when there is mutual respect in the patient-physician
relationship.
Justice
Justice in the context of medical
ethics in clinical practice is important when thinking about the distribution
of scarce health resources. When having to decide who gets what treatment the
physician should take considerations of justice into account as a guide for
allocating resources (McCullough, 1999). One concept of justice that is often
used is known as egalitarianism. The egalitarian would state that all goods
should be distributed equally between races, families, nations. The concept of
egalitarianism includes the principle that respect and opportunity be
distributed equally as well (Edge and Groves, 2005). Distributive justice
requires that the physician be seeking to equally distribute his/her healthcare
treatment with all patients. The primary concern for all physicians should be
that all patients are treated with respect, dignity, and quality care no matter
their racial background or status in society.
Dignity
Dignity is very important in
physician-patient relationships because it helps create an environment that
gives both parties a positive experience. Physicians must be especially careful
in making sure that the best interests of the patient are given utmost
attention even though there is an imbalance of power between the two (Ethics
manual, 1998). The clinician must support and respect all people and their
uniqueness, regardless of the patient’s financial arrangements, decision making
capacity and their societal status. Dignity should be shown from the very
beginning of the physician-patient relationship. On the first visit the
physician should begin by trying to understand the patient’s goals, feelings,
and complaints. The next step for both parties is to come to a mutual agreement
on the underlying problem and the goal of treatment. At this point the
clinician should present all the possible ways of treating the disease and the
pros and cons that are related with them. Once an agreement is made on the
course of action that should be taken in combating the disease, the patient can
give the physician permission to precede with the chosen therapy. Essentially,
both the physician and patient have mutual obligations in clinical
relationships. The ideal physician-patient relationship is one in which the
patient shows dignity by trusting the doctor and the doctor in return shows
dignity by caring for them on a physical and spiritual level.
Honesty
A quality that is essential in
medical ethics in clinical settings is the use of honesty. Honesty should be
the core of all communication that goes on between the patient and physician.
Therefore, the physician is required to act truthfully, to listen with great
interest/concern, and to speak only the truth. By doing so the physician creates
an environment that encourages the adult patients to trust them with sharing
all the symptoms that are related to the sickness (Ethics manual, 1998).
Patients who trust their physician will also share personal habits and their
medical history without fear when they know that confidentiality will be
upheld. This in return helps the physician to be able to make a proper
diagnosis and a better idea of how to treat the condition.
Beneficence
The concept of beneficence is that
one is required to treat all of humanity in the best way possible. Beneficence
with regard to practical applications in clinical settings requires the
physician to make decisions that are in the best interest of the patient. This requires
the physician doing so without his/her own personal gain or interests. Beneficence
is one of the principles prescribed in the Hippocratic Oath. In order to
fulfill the moral obligation of beneficence physicians should practice the idea
of lifelong learning (Rancich et. Al., 2005). This would give the physician
knowledge of the new treatments available and would ultimately lead to better
healthcare. Physicians who practice beneficence often face conflicts with
patient autonomy. This is especially the case when the physician wants to
perform a life saving treatment such as a blood transfusion but the patient
won’t allow him/her to do so due to their religious beliefs. However, physicians
should face these conflicts with compassion for the patient and continue to try
and do what is in the best interest for them.
The term double effect and medical
ethics at times seem to clash in the clinical setting. This happens when the
physician treats a patient with therapy that has the potential of causing
either a positive or harmful outcome. The combination of the two possible
outcomes is known as the double effect. The best way to describe this
phenomenon is by looking at cases in which morphine is used to treat dying
patients (Frey, 2005). When morphine is used to treat dying patients it eases
the pain and suffering of patients but at the same time it suppresses the
breathing of the patient which often causes them to die quicker. However, the
use of morphine is ethically acceptable when used to alleviate pain because
this is of the best interest of the patient, even if it shortens life. There
are moral guidelines that the physician should use when treating the terminally
ill with morphine. For example, the physician should never use morphine with
the intent to kill the patient, but using morphine to relieve pain which
unintentionally leads to the death of the patient is acceptable. Medical ethics
would therefore require the physician not to use a harmful means for a good
outcome; it must always be the reverse (Frey, 2005).
Informed consent is a practice that
all physicians should use with their patients regardless of their age or mental
capacity. This can be done by the physician through a third party. For example,
children would have their parents, and those who are not capable mentally to
make decisions normally either have family members or advanced directives. In
the past, before patient autonomy was used in healthcare, the physician would
often treat patients without informing them of their disease or the treatment
being used. Today, physicians use two types of informed consent which are
either expressed or implied (Ethics manual, 1998). Expressed consent is given
in clinical settings where the physician will give the patient written or oral
consent on the medical procedure. Implied consent is used in emergency
situations where the physician has to apply treatment in order to maintain the
life of the patient.
Informed consent in many ways
encompasses all of the previously mentioned concepts that are essential for
medical treatment in clinical settings. This concept requires the physician to
present the procedure and treatment in a way that is understandable to the
uneducated. The information should also be given in a way that is unbiased but
includes the pros and cons of various options available. During this process
the patient-physician relationship should be such that the patient feels
comfortable in sharing his/her doubts and fears. This interaction should be
such that the physician gives his/her choice of medical treatment without being
the one who makes the final decision. The basic principle behind truth telling
is that both parties must be honest with each other while keeping the best
possible results in mind (Ethics manual, 1998).
Physicians have to be in a constant
state of awareness so as to not follow their own interests. This is a difficult
task in the United States healthcare system where the costs are extremely high
and the physicians have to deal with managed care. The medical attention of the
patient should always be the primary concern of the physician. Such factors as
financial considerations that affect the physician or their own investment
should never be the guide for how to treat a patient (McCullough, 1999).
Physicians should also guard against being influenced by drug companies or
other doctors who will pay them for referring patients to them. Most physicians
enjoy providing medical care to their family members which can also cause
conflicts of interest. Patients should all be treated with the best healthcare
possible whether they are friends, family members or those that you only come
into contact with at the clinic.
Many of the medical ethics and
ethical dilemmas that physicians in clinical settings face are due to end of
life issues. This is due to the fact that often times those who are in the last
days of their life have not given instruction as to how they would like to be
treated during that time. Alternatives that are of great assistance to both the
family members involved and the physician include advanced directives and
expressed wishes (Edge and Groves, 2005). An advanced directive is very helpful
because the information pertaining to how the patient wants to be treated during
the last days of his/her life is readily available to both the doctor and the
family. Expressed wishes are only verbally known facts that the family
remembers of the wishes of the dying patient. Both are important though in that
they give information that is helpful when making such decisions as organ
donation or pulmonary resuscitation.
Palliative care of patients should be
a primary concern of the physician. The goal in palliative care is to prevent
and relieve suffering
and to improve quality of life for people facing life threatening illnesses. The
physician must understand the importance of addressing all the needs of the
patient during this time. The medical needs that the physician must treat
during this time include treatment to alleviate pain, and the psychological and
spiritual well being of the patient. The treatment chosen by the physician for
the patient during this time should never be influenced by organ donation. The
healthcare of the donor and the recipient should be taken into consideration
separately (Ethics manual, 1998). Physicians must give quality care to the best
of their ability regardless of age and the health condition in which they may
find their patient.
Treating our neighbors as we would
want them to treat us is one of the foundations of Christian faith. This act of
love alone would propel healthcare professionals to make decisions that would
benefit the patients (Meilaender, 2005). Physicians in clinics often have a
tendency to treat their patients as subjects used for an experiment rather than
human beings. This should never be the case since the primary concern of the
physician should always be to treat the patient with utmost respect, love, and
care. Medical ethics play an important role in healthcare in that they provide
a guideline as to how people should be treated. These guidelines are especially
helpful in making sure that all patients are treated equally. The most
important qualities of a doctor who follows the basic principles of medical
ethics are: integrity, honesty, respect and a yearning for lifelong learning.
Edge, R., & Groves, J. (2005). Ethics of health care. Clifton Park, NY:
Thomson Delmar Learning.
Ethics manual
(1998). Fourth edition. American college
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McCullough, L. B.
(1999). A basic concept in the clinical
ethics of managed
care: Physicians and institutions as economically disciplined moral
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Meilaender, G. (2005). Bio ethics a primer for christians. Grand Rapids, Michigan: Wm. B.
Eerdmans Publishing Co. Rancich, A. M.,Pérez, M. L., Morales, C.G., Ricardo, J. (2005).Beneficence, justice,
and lifelong learning expressed in medical oaths Journal of
Continuing Education in the Health Professions; Vol. 25 Issue 3,
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2007 from
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26, 2007 from Wikipedia. Medical Ethics (2007). Retrieved on October 22, 2007 from http://en.wikipedia.org/wiki/Medical_ethics