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Ethics, derived from the Greek ethos, or “behavior”, is concerned with questions about right versus wrong conduct and what constitutes a good or bad life, as well as the justificatory basis for such questions, the situations in which values conflict (e.g. ethical dilemmas), and the systematic analysis and resolution of these conflicts.
Health ethics is the interdisciplinary field of study and practice that seeks specifically to understand the values undergirding decisions and actions in healthcare, health research and health policy, and to provide guidance for action when these values conflict. It is distinguishable from the narrower medical ethics, which is concerned with ethical issues that arise in the clinical context related to the care of specific patients, as well as the broader bioethics, which refers to ethical issues arising from the creation and maintenance of the health of all living things.
Medical ethics comprises examining a specific problem, usually a clinical case, and using values, facts, and logic to decide what best course of action should be taken. Some ethical problems are uncomplicated, such as determining right from wrong. But others can also be more perplexing, such as deciding between two “rights” or two values that conflict with each other, or deciding between two different value systems, such as the patient’s versus the doctor’s. Often, issues in medical ethics involve life and death. Serious health issues are raised over rights of the patient, informed consent, confidentiality, competence, advance directives, negligence, and many others.
Medical ethics has a 2500-year history in medical education (books and literature), but despite this, it has only been in the last 30 years that it has “come of age” in terms of formal inclusion in medical curricula. This is partly because of the ever-increasing dangers of conventional medicine (iatrogenic diseases), the litigious society in which we live, and the escalating advancements of medical technology.
These days, healthcare practitioners come across a variety of bewildering ethical problems even in a small medical practice.
Here are some more common problems identified in a 2016 Medscape survey, where at least some physicians held different opinions:
Withholding treatment to meet an organization's budget, or because of insurance policies;
Withholding information about complementary and alternative treatments;
Accepting money from pharmaceutical or device manufacturers;
Upcoding to get treatment covered;
Getting romantically involved with a patient or family member;
Covering up a mistake;
Reporting an impaired colleague;
Practicing defensive medicine to avoid malpractice lawsuits;
Dropping insurers; and
Breaching patient confidentiality owing to a health risk.
Professional standards are a way to provide some guidance on ethical problems, but they cannot address every issue, and they may not address troubling nuances, such as reconciling two conflicting values. Many professional ethicists recommend using four basic values, or principles, to decide ethical issues:
Autonomy: Patients basically have the right to determine their own healthcare.
Justice: Distributing the benefits and burdens of care across society.
Beneficence: Doing good for the patient.
Non-maleficence: Making sure you are not harming the patient. “First do no harm.”
However, ethical values are not limited to just these four principles. There are other important values to consider, such as truth-telling, transparency, showing respect for patients and families, and showing respect for patients’ own values.
The ethical problems encountered in bioregulatory medicine rarely differ significantly from those of conventional medicine. Bioregulatory medicine is founded on not interfering with the body’s regulatory mechanisms, and therefore is safer than many conventional allopathic medicine practices. As in conventional medicine, however, there are principles from which positive duties emerge - including beneficence (a duty to promote good and act in the best interest of the patient and the health of society), and non-maleficence (the duty to protect and do no harm to patients). Also included is respect for patient autonomy (the duty to foster a patient’s informed, uncoerced choices). From this principle are derived the rules for truth-telling, disclosure, and informed consent. It also involves people skills, such as gathering the facts needed to decide and present your decision in a way that is acceptable to all parties.