Morality/Ethics in Healthcare
Morality in healthcare is the set of ethical codes that physicians must abide by in their practice, beyond simply treatment decisions but in full relation with those under their care. This set of ethics informs how physicians make decisions for their patients. Basil Varkey describes ethics as "an inherent and inseparable part of clinical medicine". A famous slogan attributed to these moral codes is a modern interpretation of the Hippocratic Oath: Do No Harm. Upon graduation from medical school, physicians must take this oath and uphold it. This oath stands on four key principles: beneficence, maleficence, autonomy, and justice. Through a united framework of these codes, physicians can provide quality medical care to patients while maintaining patients’ honor and dignity.
Beneficence
Under the principles of beneficence, a physician must act in accordance with what benefits a patient. This ethical principle allows individuals to protect and defend the rights of others, do no harm, help disabled people, and rescue those in danger. Positive action is imperative to comply with beneficence. Not only must a physician avoid doing harm to a patient, but they must also do their utmost to aid a patient’s well-being. Some scholars argue that physicians must abide by this principle as recompense to society, and/or the patient themselves, whether that debt was economic, through government subsidized education, or social, by the status gained by being a physician.
Nonmaleficence
Nonmaleficence is the obligation of a physician not to harm apatient. This principle supports several moral rules − do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life. The practical application of nonmaleficence is for the physician to weigh the benefits against burdens of all interventions and treatments, to eschew those that are inappropriately burdensome, and to choose the best course of action for the patient. This is particularly important and pertinent in difficult end-of-life care decisions on withholding and withdrawing life-sustaining treatment, medically administered nutrition and hydration, and in pain and other symptom control. A physician's obligation and intention to relieve the suffering (e.g., refractory pain or dyspnea) of a patient by the use of appropriate medications, including opioids or other sedating drugs, override the foreseeable but unintended harmful effects or outcome (i.e. doctrine of double effect).
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Justice
Distributive justice, the form of justice pertinent to clinical ethics, includes the fair, equitable, and appropriate distribution of healthcare resources. The principles of this distribution may differ according to different receivers - each person (i) an equal share, (ii) according to need, (iii) according to effort, (iv) according to contribution, (v) according to merit, and (vi) according to free-market exchanges. These principles are not mutually exclusive, and applications of distributive justice often utilize a balanced combination of these principles to coherently and equitably distribute medical resources. The allotment of limited resources, including equipment, tests, medications, organ transplants, time for patient visits, and the care of uninsured patients, all fall under the purview of distributive justice. Many questions fight for the forefront of determining the equitable path of actions. Should need or complexity take precedence? How should socio-economic status weigh on clinical decisions? While these constraints can be difficult to manage, fairness to the patients often simplifies issues pertaining to conflicts of interest. By taking on the role of a physician imperates accepting these requirements.
“A flagrant example of violation of this principle would be when a particular option of treatment is chosen over others, or an expensive drug is chosen over an equally effective but less expensive one because it benefits the physician, financially, or otherwise.” (Varkey).
Autonomy
A physician must recognize a patient’s worth and control over their own body and mind, and a patient’s unequivocal right to make properly informed and consented decisions about their own body, mind, and treatment. This ethical principle is referred to as autonomy. Two important aspects of this principle are informed consent and truth telling. Informed consent and truth telling detail how a physician must freely provide all information about treatment options, diagnoses, and overall care to the patient, thus allowing the patient to exercise true autonomy over their decision making. Respecting a patient’s autonomy is important for the physician and patient to maintain strict boundaries when it comes to care, as medical care can often put the patient in vulnerable situations that may lead the patient to feeling dehumanized. Ensuring that the patient retains direct control overall treatment ensures that all the humanity of all patients is consistently recognized by the healthcare system.
Medical ethics requires a careful and well-thought out balance between these four core principles of nonmaleficence, beneficence, autonomy and justice. Though, in practice these principles can come into tension—for example, when respecting a patient’s autonomy may conflict with what a physician believes is most beneficial. As we explore broader moral theories that apply to other real-world situations, we will learn how nuanced this balance truly is. This perspective reveals the importance of thoughtful synthesis of multiple, possibly contradictory ethical codes to solve the realities of unique, real-world situations.
Now, let's learn about moral theories