By: Nieffer Sharif
What is 'Medical Ethics'?
'Medical ethics' is a branch of ethics with a strong emphasis on clinical cases and medicine; using medical ethics, a course of action can be decided using values, logic and facts. Medical ethics are mainly used in cases of controversy such as deciding which values matter most or deciding between two value systems (i.e. patient versus doctor).
Why are Medical Ethics Important in Relation to Standards in Health and Medical Care?
Judith Resnik (a professor at Yale Law School and former astronaut) has explained five ways to address this question.
“First, ethical standards promote the aim of medical care: to alleviate suffering. For example, recruiting highly qualified medical personnel and exposing them to continuous in-service training will promote their knowledge and skills in both medical care and medical ethics, and may minimize errors.
Second, medical care is built on the communication between medical workers on one side and patients and/or patients’ families on another side. Ethical standards promote the values that are essential to good communication, such as trust, accountability, mutual respect and fair medical care. Many ethical standards in medical care, including informed consent, protection of privacy and maintenance of confidentiality, provide a grantee for respect for persons.
Third, ethical standards will help to build public support for medical care. People are more likely to pay for medical care and donate to health promoting projects if they trust the quality and integrity of these programmes.
Fourth, after the introduction of the revolving system. People started to pay for medical care. Some well-off persons use it to donate money for constructing new health facilities and sponsor health promotion programmes. This will help to ensure that health and medical care are held accountable to the public. For example, physicians and other medical workers who work in public health facilities receive their salaries from public funding. Those health workers who work in private clinics are paid by patients and should be inclined to perform their duties in a respectful manner.
Fifth, health and medical care typically involve different medical workers from a variety of disciplines. They need to work in healthy work environments that are characterized by trust, accountability, mutual respect and fairness. Ethical standards may promote the values of cooperation and collaborative work. Finally, ethical standards in medical care promote other important moral and social values such as social responsibility, human rights, patients’ welfare, compliance with the law, SMC’s regulations, and patients’ safety. Adherence to ethical standards can significantly facilitate a pleasant environment for both patients and medical workers. Medical ethics must be understood as an applied professional concept that is separate from the concept of avoiding doing harm to patients. Part of this understanding is acknowledging that health and medical professionals are confident that medical ethics, as an essential branch of general ethics, offers a valuable framework in which to define the norms for medical care. Thus, medical ethics is concerned with promoting health and medicine and clarifying norms for improving relationships between patients and physicians.”
The Hippocratic Oath:
Hippocrates (460 BCE – 375 BCE), also known as ‘The Father of Medicine’, was an ancient Greek physician who lived through the Greek Classical period. He is most commonly known for his contributions and work on medical ethics and for the creation of the Hippocratic Oath.
The original oath states:
‘I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy. In purity and holiness, I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.’
Over time, the oath has been adapted; the latest version of the Hippocratic Oath (The Declaration of Geneva) was published in 2017. The Declaration of Geneva states:
‘at the time of being admitted as a member of the medical profession: I solemnly pledge to consecrate my life to the service of humanity, I will give to my teachers the respect and gratitude that is their due, I will practise my profession with conscience and dignity, the health of my patient will be my first consideration, I will respect the secrets that are confided in me, even after the patient has died, I will maintain by all the means in my power, the honour and noble traditions of the medical profession, my colleagues will be my sisters and brothers, I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient. I will maintain the utmost respect for human life, I will not use my medical knowledge to violate human rights and civil liberties, even under threat. I make these promises solemnly, freely and upon my honour.’
The Principles of Bioethics:
Developed by philosophers Beauchamp and Childress, principles of bioethics have been adopted as part of the Universal Declaration on Bioethics and Human Rights. The following principles do not tell a doctor how to solve a problem but rather what to consider when making a decision.
1. Autonomy: doctors must have respect for the patient and their ability to make personal decisions regarding their future and their health
2. Beneficence: a doctor should act in the best interest of the patient – ‘Do no harm’
3. Non-maleficence: any action taken should be intended not to harm the patient or others
4. Justice: being fair to the wider community in terms of consequences and actions
5. Dignity: the patient always has the right to dignity
Confidentiality:
Although confidentiality is not one of the 5 main principles of bioethics and although there is no legal requirement to maintain confidentiality, it is still one of the four ethical principles as confidentiality plays a key role in doctor patient relationships and trust; if a patient knows that their doctor is morally obliged to keep their conversations private, the patient is more likely to confide in the doctor meaning that it is easier for doctors to get to the root of the problem.
However, doctors are allowed to disclose information when:
The patient gives consent to disclose information
The patient is lacking capacity to give consent and the disclosure will benefit the patient
The disclosure is required by law
The disclosure can be justified in public interest
Consent:
Consent must always be given; it is necessary when having a simple discussion with a doctor all the way to undergoing lifesaving treatments. In order for consent to be legally valid the consent must be voluntary, meaning that the patient has not been influenced by relatives, medical professionals or anyone else. The patient must also be informed about the procedure prior to seeking consent. The patient should also have the capacity to give consent meaning they should be able to understand the information presented to make a decision. Consent can be given verbally, written or nonverbal/assumed (e.g. pulling up your sleeve for a blood test) However, consent isn’t necessary in cases of emergency, if the treatment could save their lives or if the patient has a severe mental condition in which they don’t have the capacity to make a decision. In the UK this is interpreted slightly differently as instead of doctors taking the declaration of Geneva or any other binding oath, there are set values and principles made by the General Medical Council (GMC) that are known as the ‘Good Medical Practice.’ The Good Medical Practice outlines how doctors and medical students (and anyone else providing healthcare) should behave; the GMC has split a medical professional’s duties into four different categories:
“Domain 1 - Knowledge skills and performance
Develop and maintain your professional performance
Apply knowledge and experience to practice
Record your work clearly, accurately and legibly
Domain 2 - Safety and quality
Contribute to and comply with systems to protect patients
Respond to risks to safety
Risks posed by your health
Domain 3 - Communication partnership and teamwork
Communicate effectively
Working collaboratively with colleagues
Teaching, training, supporting and assessing
Continuity and coordination of care
Establish and maintain partnerships with patients
Domain 4 - Maintaining trust
Show respect for patients
Treat patients and colleagues fairly and without discrimination
Act with honesty and integrity”
Takeaway:
Medical ethics are a vital part of the field of medicine by allowing doctors and healthcare professionals to adequately provide care in a safe environment where the patient and their values are put first.
Works Cited
Medscape Log In, www.medscape.com/courses/section/898060.
“Greek Medicine - The Hippocratic Oath.” U.S. National Library of Medicine, National Institutes of Health, 7 Feb. 2012, www.nlm.nih.gov/hmd/greek/greek_oath.html.
“Principles of Bioethics.” Principles of Bioethics | UW Department of Bioethics & Humanities, depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics.
Smith, Wesley D. “Hippocrates.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., 18 May 2020, www.britannica.com/biography/Hippocrates.
“The Duties of a Doctor Registered with the General Medical Council.” GMC, www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/duties-of-a-doctor.
theMSAG. “The Importance of Medical Ethics.” TheMSAG, themsag.com/blogs/medical-school-interviews/the-importance-of-medical-ethics.
Edited by: Simoni Shah
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