Law > Medical Jurisprudence > Medical Ethics
Morality and ethics are exclusively matters of human concern. It is deeply influenced by several factors, such as history, traditions, education and culture, and so on. The term ‘ethics’ refers to understanding and implementing moral values within a society. It is related to the value perspectives and principles that regulate our daily activities. Ethics is the study of the rightness or wrongness of human conduct or the philosophical study of morality. The term ethics is derived from ethos, which means the distinguishing character or guiding beliefs of a person, institution, etc. Different branches of ethics are Metaethics, normative ethics, and applied ethics. Metaethics studies philosophical questions about the meaning of ethical words, or the nature of ethical facts. Normative ethics studies what features make something good/bad, an act right/wrong, or a trait virtuous or vicious. Applied ethics deals with difficult moral questions and controversial moral issues that people actually face in their lives. Medical ethics is a branch of applied ethics.
Applied Ethics:
Applied ethics deals with difficult moral questions and controversial moral issues that people actually face in their lives. Applied ethics is further classified into three types: bioethics, business or professional ethics, and environmental ethics. Bioethics refers to the study of ethical issues in healthcare, reproduction, biology, and genetics. Business or professional ethics is the application of theories of right and wrong to transactions and activity within and between commercial enterprises and between commercial enterprises and their broader environment. Environmental ethics deals with questions of rightness and value regarding our relationship with the rest of the natural world.
Bioethics:
Bioethics refers to the study of ethical issues in healthcare, reproduction, biology, and genetics. It includes in its scope, medical ethics, nursing ethics, and ethical issues raised in the other paramedical and welfare professions such as psychiatric care and social work. It also refers to a number of moral issues that arise in the context of life-saving and life-enhancing technologies, reproductive technologies, and the technology that concerns genetic engineering. Broadly bioethics refers to ‘medical ethics’ and the social, ethical, economic problems in the context of medical ethics. It includes social issues like abortion, suicide, euthanasia, surrogacy, informed consent, doctor-patient relationship, etc.
Medical Ethics:
Medical ethics, though a part of bioethics, has now become a separate discipline in itself due to its vast area of inquiry. Medical ethics is the analysis of choices and decisions in the medical sphere. It includes the rights and obligations of patients and physicians on the basis of social values. It has to consider not only health care but also a harmonious living of human being in society. The development of medical ethics took place not only by the progress of science but also by the progress of human thinking. The historical progress of humanity and the concept of human dignity have also been reflected in the progress of medical ethics.
Four Principles of Medical Ethics:
Tom L. Beauchamp and James F. Childress in their book “The Principle of Biomedical Ethics” proposed four principles of medical ethics. These principles are
- The Principle of Autonomy
- Non-maleficence
- Beneficence and
- Justice
The Principle of Respect of Autonomy:
Autonomy literally means self-rule and it refers to the ability to act independently without the influence of others. It is the capacity to think, decide and act out of the freedom of thought of one’s own. It also includes liberty, rights, choice, individual privacy, freedom of will, and acknowledgment of the capacity of an individual to make his/her own decisions, etc. the social and economic conditions of the patient determine the autonomy. In medical practice, autonomy is usually expressed as the right of competent adults to make informed decisions about their own medical care. The principle underlies the requirement to seek the consent or informed agreement of the patient before any investigation or treatment takes place. Where patients lack the capacity to make a decision, it follows necessarily that decisions must be made on their behalf. Family or friends stand as important agents in decision-making when medical professionals deal with the chronic condition of a patient.
In the medical profession, the principle of autonomy means that patient has the autonomy to act independently and to take decisions on the basis of information received from physicians, and choose a course of treatment. Similarly, for taking a decision, the patient and the patient’s family should respect other fellow patients and physicians. Neither the patient nor the decision should be either controlled or imposed upon him by another individual or a group of individuals. It is to be noted that an infant, lacks this competence to take decisions, and thus the question of autonomy in the context of medical decisions in the case of infants does not arise. Similarly, a patient in a vegetative state or in a coma is incapable of making medical decisions.
Requirements:
- The patient has full autonomy of thought, intention, and action when making decisions regarding health care procedures.
- The decision-making process must be free of coercion or coaxing.
- In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.
The Principle of Non-maleficence:
The principle of non-maleficence expresses the rule “do not harm”, which means we should not intentionally create harm or injury to others either through acts of commission or omission. This principle of non-maleficence has greater importance in the medical field because the negligence or carelessness of health care professional creates harm to patient.
According to Childress and Beauchamp the principle of non-maleficence includes number of specific moral rules which supports a number of specific rules, including the following:
- Do not kill.
- Do not cause pain or suffering.
- Do not incapacitate.
- Do not cause offense.
- Do not deprive others of the good life
There are however many occasions when the physician has to cause some harm to the patient, which results in some good of the patient himself. Such an action won’t be termed as a violation of the principle of non-maleficence. For example, during surgery, the surgeon uses sharp edged instruments for conducting operations, which is beneficial for the patient. A harmful act will be considered justifiable when there is a just and lawful excuse for the apparent harmful act. Thus according to this principle, no deliberate harm is caused to the patient and also makes certain that if any harm or injury is inevitable it is only in order to bring about a greater good to secure the patient’s health.
Principle of Beneficence:
The term beneficence denotes acts of mercy, kindness and charity. It includes love, altruism and a sense of humanity. Under the principle of beneficence, one ought to prevent harm and promote good. According to Childress and Beauchamp, the principle of beneficence supports a number of specific rules, including the following:
- Protect and defend the rights of others
- Prevent harm from occurring to others.
- Remove conditions that will cause harm to others.
- Help persons with disabilities.
- Rescue persons in danger
Try to understand in the principle of non-maleficence the rules are negative. They start with “do not”, while in the principle of beneficence are positive. They ask prompts the health care provider to take a positive step to prevent harm to the patient. But the principle of beneficence raises the question of who should be the judge for the best of the patient.
Principle of Justice:
Principle of justice in medical ethics means that medical resources should be available to all patients in an equitable manner. For example, if there are two patients in a hospital, both in a similar situation with reference to the state of health, they ought to be treated in exactly the same manner regardless of their financial or social status. This principle of justice is traditionally attributed to Aristotle and it says that equals must be treated equally and unequal must be treated unequally. This principle of justice is also called the principle of formal equality. In medicine all persons irrespective of age, sex etc. should be equally treated in terms of medical care.
According to Childress and Beauchamp, proposed each of the following principles as a valid material principle of distributive justice;
- to each person an equal share
- to each person according to need
- to each person according to effort
- to each person according to contribution
- to each person according to merit
- to each person according to free market exchanges
Case Study:
Let us study the principles of medical ethics with the following case study: A middle aged married female patient has an ovarian cyst that, if left untreated, will result in renal (kidney) failure. An operation to remove the cyst is the best treatment for the problem. The patient is frightened of needles and is against the surgery.
In given case study the patient is frightened of needles and is against the surgery (her autonomy). For performing the operation anaesthesia must be administered using needles. During surgery, sharp-edged instruments are used for making cuts in the body. During operation under the influence of anaesthesia, she may not feel the pain but when the effect of anaesthesia diminish she can feel the pain inflicted during the operation. The medical professional must work with the patient to respect the fact that she dislikes needles and doesn’t want the operation, and must explain the benefit of being operated that the operation would prevent her from going into renal failure, which is in her best interest (beneficence). This principle of beneficence clashes with the principle of respect for autonomy. The benefits of acting beneficently would need to be weighed against the dis-benefits of failing to respect the patient’s autonomy. If without getting consent from the patient, if she is administered anaesthesia, she would resist and may get harmed. The health professional should avoid anything that would harm the patient (non-maleficence). Now the decision of patient should be viewed with respect to other patients. The doctor needs to consider the impact that the patient’s choices might have on others if she starts to go into preventable kidney failure, she’ll need dialysis, which affects other people who need the same treatment (justice). Similarly, the cost-effectiveness of patient’s decision must be considered. Thus before making the final decision the doctor must consider all the four principles of health care ethics, which will help the physician make the choice that will have the best possible benefits for both the patient and society.
UNESCO Universal Declaration on Biomedical Ethics and Human Rights:
UNESCO has contributed to the formulation of basic principles in bioethics through in particular the Universal Declaration on the Human Genome and Human Rights, adopted unanimously and by acclamation by the General Conference in 1997 and endorsed by the United Nations General Assembly in 1998, and the International Declaration on Human Genetic Data, adopted unanimously and by acclamation by the General Conference on 16 October 2003
The UNESCO Universal Declaration on Biomedical Ethics and Human Rights identifies fifteen biomedical principles
- Human dignity and human rights.
- Benefit and harm.
- Autonomy and individual responsibility.
- Consent.
- Persons without the capacity to consent.
- Respect for human vulnerability and personal integrity.
- Privacy and confidentiality.
- Equality, justice and equity.
- Non-discrimination and non-stigmatization.
- Respect for cultural diversity and pluralism.
- Solidarity and cooperation.
- Social responsibility and health.
- Sharing of benefit.
- Protecting future generation.
- Protection of the environment; the biosphere and biodiversity.
Conclusion:
Medical ethics is the analysis of choices and decisions in the medical sphere. It includes the rights and obligations of patients and physicians on the basis of social values. It has to consider not only health care but also a harmonious living of human being in society. The four principle of ethics applied to the field of medicine are that of autonomy, non-maleficence, Beneficence, and justice. According to these principles for a patient’s choice to be autonomous, the decision taken by the patient ought to be a voluntary one, the choice made by the patient must be adequately informed and the patient must have the capacity to take the decision. Similarly, no deliberate harm is caused to the patient and also makes certain that if any harm or injury is inevitable it is only in order to bring about a greater good to secure the patient’s health and for the benefit of the patient. A care should be taken that medical resources are available to all patients in an equitable manner.