Medical Ethics

Six of the values that commonly apply to medical ethics discussions are:
1. Autonomy – the patient has the right to refuse or choose their treatment. he principle of autonomy recognizes the rights of individuals to self determination. This is rooted in society’s respect for individuals’ ability to make informed decisions about personal matters. Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient rather than medical professionals.

Psychiatrists are often asked to evaluate a patient’s competency for making life-and-death decisions at the end of life. Persons with a psychiatric condition may not have the capacity to make end-of-life decisions. Therefore, for these persons, a request to refuse treatment may be ignored. Unless there is a clear advance directive to the contrary, persons who lack mental capacity are generally treated according to their best interests. On the other hand, persons who have the mental capacity to make end-of-life decisions have the right to refuse treatment and choose an early death if that is what they truly want. In such cases, psychiatrists should be a part of protecting that right.

2. Beneficence – a practitioner should act in the best interest of the patient. The term beneficence refers to actions that promote the well-being of others. In the medical context, this means taking actions that serve the best interests of patients. However, uncertainty surrounds the precise definition of which practices do in fact help patients.

3. Non-maleficence – “first, do no harm” .
It is not only more important to do no harm than to do good; it is also important to know how likely it is that your treatment will harm a patient. So a physician should go further than not prescribing medications they know to be harmful – he or she should not prescribe medications (or otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh the likely risks.

Autonomy can come into conflict with Beneficence when patients disagree with recommendations that health care professionals believe are in the patient’s best interest.
However, many other societies prioritize beneficence over autonomy. On the other hand, autonomy and beneficence/non-maleficence may also overlap. For example, a breach of patients’ autonomy may cause decreased confidence for medical services in the population and subsequently less willingness to seek help, which in turn may cause inability to perform beneficence.

4. Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

5. Dignity – the patient (and the person treating the patient) have the right to dignity.

6. Truthfulness and honesty – the concept of informed consent has increased in importance since the historical events of the Doctors’ Trial of the Nuremberg trials and Tuskegee Syphilis Study.

Informed consent in ethics usually refers to the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes. It does not specifically mean the process of obtaining consent, nor the specific legal requirements, which vary from place to place, for capacity to consent. Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party. If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next of kin make decisions for them. The value of informed consent is closely related to the values of autonomy and truth telling.

is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege. Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.

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