Medical Ethics for Physicians __________________________________________________________________
context, probabilities, and one’s professional judgment, while no less dire, may assist the individual by giving him or her a sense of freedom and participation in the decision-making process. Whether an ethical dilemma exists or not should be the first question. It may simply be conflict arising out of poor communication, which is usually resolved when clarification occurs. Once an ethical dilemma or conflict is determined to exist, one can begin a step-by-step process to open the discourse and begin the decision-making process. There are a myriad of ethical issues facing patients, families of patients, and physicians today. Examples of these issues include organ transplantation, fetal surgeries, infants with severe anomalies, lifesaving surgery, stem cell research, inability to reach health services, and the rationing of healthcare. Still other issues involve competency of healthcare workers, nurse- physician relationships, treating non-compliant patients, and many more situations that apply to individuals or to the nation on a societal level. One of the most common ethical issues facing healthcare professionals in patient care settings is the withholding or withdrawing of treatment. Most healthcare institutions are required to have policies and procedures in which the rights of the patient/family and the duties of the healthcare professionals are outlined. It is only when there is a conflict between the parties involving value or moral principles that a dilemma may arise. Often, the real problem may be one of three non-ethical related issues: poor communication between the involved parties, an administrative misunderstanding, or a legal ambiguity. The first step that should be taken is to gather information about the patient’s diagnosis, prognosis, and treatment options, followed by the best medical judgments regarding life expectancy and quality of life with or without treatment. This must include a discussion of the risks and side effects of such treatment. Of equal importance, the patient (if legally competent) must be fully informed and have his or her statement of wishes honored. Should the patient be temporarily or permanently unable to speak for him or herself, the immediate family, if available, should be consulted. As discussed, most statutes on the right to die, withholding and withdrawing life sustaining treatment, and organ donation identify an individual’s immediate family member (usually in a specific order of priority) who can speak for the individual. One question to ask the patient, if competent, is whether or not he or she has an advance directive. This is usually accomplished by the nursing staff, but all healthcare professionals should be certain that it has been done. Administrative factors, such as the risk of liability, current institutional policies, and economic factors that affect the individual family, must also be evaluated.
ETHICS AND THE DECISION-MAKING PROCESS Ethical decision making is the generic term for the process of making a decision within an ethical context in a specific setting (e.g., business, education, or medicine). Ethics are the beliefs an individual or group maintains about what constitutes correct or proper behavior [11]. To put it simply, ethics are the standards of conduct an individual uses to make decisions. The term morality is often confused with ethics; however, morality involves the judgment or evaluation of an ethical system, decision, or action based on social, cultural, or religious norms [11; 12]. The word “morals” is derived from the Latin word mores, which translates into customs or values. The foundation from which ethical principles originated began from debates and discussions in ancient times. These ethical principles then became the theoretical framework upon which actions as individuals and societies are based. Most prominently, the Hebrew biblical covenants and the teachings of Greek philosophers, such as Plato and Aristotle, form the basis for most of the familiar ethics and morals prevalent in Western society today. How then are theoretical ethics translated into the day-to-day practical application of those principles in today’s rapidly changing, technology-driven world? It really boils down to a deductive reasoning process that starts with the broad and generally accepted ideas of what constitutes proper respect for the individual and how people should act within society. Then, the process narrows in focus to a smaller group or individual situation in which the ethical principles serve as a guide for daily living. When a situation presents itself that contradicts the established “norm,” it may cause a dilemma. When these dilemmas are of an ethical nature, we often say the situations are controversial or have called into question or infringed upon a group or individual’s rights based upon accepted ethical theories and moral practices. How does one move from general ethical concepts, based on religious or philosophical theoretical frameworks (discussed later in this course), to practical application for patient/society healthcare decision making? Ordinarily, an ethical conflict presents itself when a person’s or group’s ethical values or principles are challenged or conflict with one another over some decision related to clinical care. It is imperative to identify what principles or values are in conflict so that an appropriate resolution can be made. A dilemma occurs when one is faced with what is perceived (or is in reality) to be no alternative, only one alternative, or an either/or choice situation. This dilemma scenario leaves the individual with limited, often painful choices. “Have the surgery or die,” may be the only two alternatives given to a patient. This can leave the patient immobilized, powerless, feeling subservient and victimized, and with no sense of control. Providing options accompanied by explanation,
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