Basic principles of medical ethics..

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Physicians deal with many ethical issues on a daily basis. Fundamental ethical principles assist us in understanding, negotiating and navigating these issues. Ethical dilemmas arise when two or more ethical principles apply in a particular case and would lead to different outcomes. In these situations physicians must balance these principles to arrive at the best course of action. There are other approaches to bioethics in which other principles may apply. However, in caring for patients, it is important for physicians to understand the following fundamental ethical principles:

Autonomy: “Self rule”- Physicians must respect a patient’s right to make decisions regarding his medical care. Competent, informed patients have the right to choose among treatment options and refuse any unwanted medical interventions. By providing informed consent and following patients’ wishes, physicians demonstrate their respect for the patient’s autonomy.

Beneficence: Physicians must act in the best interests of their patients. Patients are vulnerable because of illness and lack medical expertise. Therefore, patients rely on physicians to offer sound advice and to place the their well-being first. If patients lack decision-making capacity, they need to be protected from making decisions that are contrary to their best interests. Physicians must put the interests of their patients ahead of their own interests or those of third parties such as insurers or managed care organizations.

Confidentiality: Physicians must maintain the confidentiality of medical information. Confidentiality respects patient autonomy and encourages patients to present for care and be candid. However, confidentiality can be overridden in order to protect third parties when there is the potential for serious, foreseeable harm to third parties. Legally mandated reporting includes certain infectious diseases like tuberculosis, loss of consciousness or child or elder abuse or domestic violence.

Do no harm: The principle of non-maleficence directs physicians to “do no harm” to patients. Physicians must refrain from providing ineffective treatments or acting with malice toward patients. This principle, however, offers little useful guidance to physicians since many beneficial therapies also have serious risks. The pertinent ethical issue is whether the benefits outweigh the burdens.

Equality: The principle of distributive justice deals with issues of treating patients equally. Physicians should treat similarly situated patients similarly and allocate resources justly. In the face of limited health care resources, physicians should practice cost-effective medicine. Physicians should make recommendations and decisions based on ethically pertinent considerations.

Fairness: The principle of procedural justice requires that the process for making decisions for patients be fair and just. For example the process by which patients appeal rulings by the insurance company or by which organs are allocated must be fair and just.