Ethical Decisions in the Medical Health Profession - Essay Example

Essay: Ethical Decisions in the Medical Health Profession The term ethical can be used in decisions of the Council on Ethical and Judicial Affairs concerning to issues relating to foremost moral practices or principles and secondly matters touching on social policy that involves issues pertaining morality in the medical health profession. The opposite of ethical is unethical a term that means professional conduct that fails to conform or rather comply with the laid down medical moral policies or standards. Several of the Council’s judgments lays out particular obligations and duties for medical practitioners such as nurses and physicians on which they should base their decisions as they practice in their respective fields. Any violation of these judgments and opinions characterizes unethical conduct and could lead to justification of disciplinary actions like censure, expulsion or suspension from the medical field society membership. Over the years medical practice has been evolving in ways that draw attention to the significance of ethical decisions and issues. Medical science has gotten involved in practices that were previously not possible such as stem cell and genetics research, the modern day patient is better informed, lawsuits are quite common which means medical practitioners have to be generally more aware of their medical decisions and cost implications of their services to society. They have a huge task of juggling their obligations to hospitals, the regional health and the government of the day. Keywords: ethical, unethical, violation, medical practioner, expulsion, Council on Ethical and Judicial affairs, medical practitioner Introduction Ethics broadly deals with what is right or wrong, or basically what we are supposed to do and what we ought not to do. Medical ethics decisions therefore concerns how to make judgments on how to deal with moral issues arising out of caring for parents and such decisions therefore have to make a consideration of just more than the patient’s current medical condition. Ethics is just not just a medical field thing; there are also other disciplines that are concerned with these issues such as theology and law which also prescribe to certain behaviors set aside by their respective governing councils. The Relationship between Ethical Decisions and Law Medical ethical decisions, values and laws are mostly closely related; however medical ethical responsibilities exceed legal obligations. In some instances, the law may allow unethical conduct. In several instances when medical practitioners hold the belief that a certain law is not just for their making critical decisions, they then ought to start working towards changing that law. In very unique cases regarding unjust laws, the prevailing ethical responsibilities should take the place of legal obligations. The fact that a medical practitioner charged for allegedly conducting himself or herself with conduct is exonerated or acquitted in criminal or civil proceedings does not essentially mean that the concerned medical practitioners acted ethically. “Ethical issues arise when not all values can be respected. The values in conflict must then be prioritized and the essence of ‘doing ethics’ is to justify breaching the values that are not respected.”(Margret Somerville, November 2008).There is a difference between ethical rows based on set values, called “principlism” and arguments that are more flexible in nature whereby the circumstances of the given case influence the making of a decision, called “casuistry” or rather an argument based on a case. Theory here plays a small responsibility, and decisions are arrived by making a reference to patterns that demonstrates accepted suitable ways of behaving. Pillars of medical ethics The following are some traditional and modern pillars of medical ethics, where medical practitioners are bound to make very significant ethical decisions, which can have significant effects on patients; Patient’s Autonomy Respect for the patient’s autonomy refers to the the ability to reason and make a decision on a person’s own free will. This specific principle puts into account and recognizes a patient’s rights to self-determination, which is rooted firmly in society’s reverence for a person’s ability to make decisions that are informed concerning personal matters. Autonomy has emerged out significantly since the shifting of social values to defining medical quality in regard to results that are crucial to the welfare of the patient rather than professionals in the medical field. Autonomy generally indicates health and several diseases are most of the time exemplified by autonomy loss, in various ways, leaving autonomy as an indicator of both the well-being of the heath profession as well as personal well-being for the patient. This has got serious implications for the medical practitioners’ reflection of existing medical ethics, begging the question whether the objective of health care is to do good and profit from it? Or rather is the objective of health care to do others good, and have the society and them profit from this? Ethics by definition and in general tries to look for a profitable balance amongst individual’s activities and its results collectively. Clinical psychologists and Psychiatrists are most of the time being requested to make an evaluation of a patient’s ability to making life-and-death resolution, at the last part of life. Individuals suffering from psychiatric condition such as clinical depression or delirium may lack the ability to make end of life judgments and this is where medical professionals may come to the aid of the patient and family. For instance the request by these patients to discontinue treatment, may be regarded in their condition and not necessarily be followed per se.Medical practitioners (physicians, nurses) should assist a patient arrive at their own decisions by providing them with full information and should respect a decision by a competent adult patient, even though it seems to be medically wrong. Beneficence Beneficence is simply promoting what is best for a patient. This is where the general moral principle of being good to another person is highlighted by the virtue of being in a caring professional relationship. Beneficence simply refers to consideration of the patient’s pain; their mental and physical suffering, the risk of death or disability and their overall quality of life. If the therapy or benefit is minimal, at times, beneficence can mean not intervening.Generally, beneficence may also refer to the decisions and actions that medical practitioners may take to promote other’s well being. In medical field, this simply means making decisions and taking actions that serve as the best interests of patients. There could be uncertainty surrounding precisely the definition of what practices do assist patients. Non-maleficence Non-maleficence means do not harm-this adds to the principle of beneficence. This is considered to be the primary or main consideration, that it is actually more important to not harm your patient, than doing them good. This is because some medical enthusiasts could be tempted to making decisions on using medications believing that they are doing their patients good, without having first evaluating them enough to make sure they don’t(only allowable levels) of risk or harm. Most treatments have got side-effects or may involve some risk. Many patients have been harmed so much as a result of this. Not only is it prudent, not to do no harm than doing good, it’s very prudent for the medical practitioners to understand how their choice of treatment might be harmful to their patient. It is advisable therefore that a medical practitioner goes further than not just recommending prescriptions they understand are harmful-s/he should by no means recommend prescriptions (or else treatments for the patient) unless s/he is aware that the given treatment is not likely to harm the patient or at least that the patient is aware of the benefits and risks, and that the given benefits outweigh the possible risks. Thus this principle makes medics remember the possibility of harming a patient, more so when they cannot cure. Practically though, in everyday practice several treatments carry with them some inherent danger of harm. In certain circumstances such as desperate situations, and the results of no treatment would be grave, dangerous treatments that have got higher chances of harming a patient can be justified, since the danger of withholding treatment is most likely to harm the patient. A medical practitioner must therefore make a sober decision while faced by such a predicament. Double effect Double effect could refer to two kinds of outcomes that might be generated by a particular deed and could be regarded as the merged result of non-maleficence and beneficence in medical ethics. A very commonly used illustration of this occurrence is the using of morphine or/and other analgesic for a dying patient. This is a very significant ethical decision that practitioners can make, since using morphine usually has the beneficial result of not only easing the suffering and pain of the patient, but also simultaneously has the maleficent effect of reducing the patient’s life via suppression of his/her respiratory system. Medics are usually in dilemma of what course of action to take in cases such as this. Justice There are limited resources and thus everybody cannot be cured, and therefore there has to be priorities. The justice principle, states that in allocating care, patients that are in the same situations should be given the same care and while allocating resources to a certain group we should consider the impact of this decision to other people. Whereas the primary duty of a physician is to his/her patient, others could be affected by the decisions made by you and tension could result between autonomy, justice and beneficence. Confidentiality This particular principle forms the bedrock of doctor-patient interactions, which is increasingly difficult to maintain in this era of electronic data. In order for this trust and relationship to be maintained, the concerned physician should never release private medical information devoid of patient’s consent. Confidentiality just like other ethical roles, is not absolute and its sometimes necessary to override privacy in regard to public health for instance when contact tracing partners of a patient suffering from a sexually transmitted disease. A medical practitioner is obligated to make an ethical decision and inform the public health regulators of an HIV suffering patient, and should be done in a manner that reduces harm to the concerned party. Disclosure Disclosure-a patient must be informed so as to make choices that are informed (autonomy), a physician is therefore bound to disclose material information that is relevant to the patient’s accepting of their situation, their options for treatment and most likely outcomes in their scenario. This is inclusive of information on any possible medical errors committed in their period of care. In accordance to the American College of Physicians creed, “Errors do not necessarily constitute improper, negligent, or unethical behavior, but failure to disclose them may.”Certain circumstances abound where a medical practitioner may choose to withhold information to the sick person, including a situation where a patient has specifically requested not to be informed,(though you should still give them a chance to know the facts as they are),in case of an incapacitated patient(the family in this case is informed),in case of an emergency and the patient’s condition is not stable and immediate attention is required and the contentious perception of “therapeutic privilege “meaning that the physician considers that the danger of letting the patient know is worse than not disclosing anything(for example they could attempt suicide or reject important treatment). Informed Consent Informed consent follows from the autonomy of patient principle, and consent is necessary before the provision of care is done.”No medical intervention done for any purpose-whether diagnostic,investigational,cosmetic,palliative,or therapeutic –should take place unless the patient has consented to it ”(Hebert,p.84).This informed consent serves as a considerable blanket to the medical practitioner against possible lawsuit. Consent might be implied or expressed. Expressed consent can occur through a signed form of consent and mostly happens at hospitals and is related to particular procedures. Consent can be verbal but a consent form gives evidence of consent. Consent is not a contract and a patient can withdraw it any time. However for regular procedures such as checking blood pressure, consent might be implied if a patient voluntarily presents herself/himself to the doctor for checkup. For informed consent, a patient must be informed of the full description of the specific course of action, the benefits and risks, likely scenario with or without treatment, and the alternative medications. The patient should be having the correct frame of mind to understand the given information, and should give the physician express authorization to continue with the specified plan. The burden is not restricted to the physician; the concerned patient should make inquiries in case they are unsure and should carefully think about their available choices. Human rights respect The era of human rights began when the UN was formed in 1945 and was mostly charged with human rights promotion. The first ever document to make a definition of human rights was The Universal Declaration of Human Rights in 1948.Medical practitioners world over thus, have an ethical duty of protecting human dignity and human rights of their patients always. However the appearance of a document defining human rights has had a profound effect on many medical ethical decisions. Most codes nowadays in medical ethics require that there be respect for the patient’s human rights and dignity. Several councils and conventions in various countries such as Europe have come with uniform codes of medical ethics for medical practitioners in all of its 47 member countries. These codes have provided special defense of physical integrity especially those that cannot consent such as children. For instance no tissue or organ can be removed out of a person’s body if s/he is unable or lacks the capacity to assent or consent. In the process of advancing and applying scientific knowledge, medical practitioners and associated parties should make sober decisions bearing in account the vulnerability of human beings. Medical practitioners should thus be able to protect and respect personal integrity of such groups of people and individuals. Decisions in Euthanasia Euthanasia refers to a practice of deliberately ending the life of a patient to relieve suffering and pain. It is something understandable, even though it is tragic, that several patients especially those in extreme duress, like those with terminal, delibatating and painful sickness, may opt to prefer death than life. However empowering the medics to carry out euthanasia would finally cause more damage than good. Euthanasia is primarily unsuited with medical professional’s role of treating, healing or caring and would thus be difficult to control, posing serious societal dangers. For instance, physicians’ involvement in Euthanasia would heighten the importance of its ethical restriction. The medical professional who carries out euthanasia makes a critical ethical decision and assumes exceptional role of putting an end to the life of the patient. There are also valid fears that euthanasia could be readily extended to patients who are incompetent and other populations that are vulnerable. Each country has got different euthanasia legislation. Though not a medical pillar; this is another aspect of medical health that has raised a lot of debate. Euthanasia is classified in various ways which include involuntary, voluntary and non-voluntary. Voluntary euthanasia is allowed in the US and some other countries, whereas non-voluntary euthanasia is not allowed in all nations. Involuntary euthanasia is typically considered murder. Medical practitioners have faced dilemma over this issue. There is lots of public controversy regarding the ethical, legal and moral issues regarding euthanasia. Opponents of euthanasia argue for life’s sanctity, whereas proponents of euthanasia lay emphasize on alleviating pain and suffering, bodily integrity, personal autonomy and self-determination. Instead of performing euthanasia, medical professionals should instead aggressively be responsive of patient’s needs at their last days of their lives. Patients should be shown more care, kindness and love and not be left alone if found out that there is no cure for their illness. Thus patients at the end of their lives must be given lots of attention, emotional support, enough pain control, respect for the autonomy of the patient, good communication and comfortable care. Parental consent to abortion, Ethical decisions on mandatory parental consent to abortion have caused medical practitioners to be faced with a lot of challenges when they encounter such issues in their professional lives. They should therefore encourage minors to have discussions of the pregnancy foremost with their guardians and parents. Medical practitioners thus have a role to play in explaining how parents should get involved and the way it is helpful. Parents are generally very supportive and understanding. If the child expresses concerns about the involvement of the parents, the physician should be in a position to understand that the child’s reluctance is not on the basis of any misperceptions concerning the likely results of their parents’ involvement. Medical practitioners should not compel minors to have their parents involved before making a decision on whether to procure an abortion. The patient, who could be an adolescent, should generally decide whether, if at all involvement of parents in the whole issue would be ok with them. Medical practitioners should be able to make an explanation under what situations, such as life-threatening emergencies, the confidentiality of the minor will require to be abrogated. The specific physicians should ensure that underage patients make an informed decision after carefully considering the involved issues. Physicians should make a decision of advising the young patients to seek alternative sources, if their parents are not willing to get involved in the minor’s decision. The affected minor should be free to look for advice and counsel of the people they are confident in, including relatives, professional counselors, friends, clergy or teachers. Commercial use of human tissues. Biotechnology industry has led to the availability of numerous commercial therapeutic and other related products made from and using human tissue. For physicians thinking of using human tissues for commercial purposes should consider the following before making that vital ethical decision; There ought to be an informed consent which must be gotten from the specific clients for using their tissues or organs for clinical purpose. All potential and future commercial applications should be disclosed to the concerned patient even before realization of products made using biological materials. Any use of human tissue and any products emanating from the same, should not be exploited for commercial reasons without the prior informed consent of the individual from whom the initial cellular material was removed. All profits accrued from the commercial exploitation of the particular human tissue and all its products must be shared with the specific patient, according to the available legitimate contractual agreements. The therapeutic and diagnostic alternatives provided to patients by their medical professionals should be in conformity with the standards of proper medical practice expected of medical fraternity and not necessarily influenced by the commercial possibilities from the patient’s organs and tissues. Physician assisted suicide Doctor assisted suicide takes place when medical professional facilitates the death of a patient by aiding in the provision of the required means or/and information which assists the patient to carry out the act of killing self. Thus the doctor may provide information regarding lethal dose or sleeping pills with the knowledge that the patient may kill herself/himself. This may leave many medical professional in dilemma as to what decision they may make. Instead of involving themselves in assisting patients to commit suicide, physicians should be responsive of their patients’ needs and should not abandon them during their time of need. Medical professional should look for multidisciplinary interventions to assist their patients and see to it that they get family counseling, specialty consultancy and other comforting modalities. Conflict of interest From time to time, medical practitioners may find themselves in conflicts of interest as they undertake various professional duties. Medical practitioners should not at any particular time allow conflict of interest to cloud their judgments on matters medical. They should make their decisions when they are very sober and not at all biased, since they have been entrusted by the care of people’s lives. Though at times, it could be hard to avoid conflicts, medical professionals should know how to detach themselves from such situations in a way that is wise. Conflict of interest may occur in a situation such as the treatment of family members. Thus doctors who undertake to treat members of their own family should be very vigilant so as to avoid conflicting interests or treating the patient inappropriately. Another instance of conflict of interest may occur while treating a sexual partner. Thus sexual relationships may occur between physicians and their patients and this can result in ethical conflicts. Sexual consent between a physician and his/her patient may result into conflict due to the fiduciary role of the medical professional. Another cause of conflict of interest may result from referral made by the doctors who particularly get some income from doing so. This makes the medical practitioner to refer patients for tests so that they can earn more. This practice is however proscribed in the US. Vendor relationships may exist between pharmaceutical companies and medical practitioners. Medical practitioners may be influenced by pharmaceutical company’s inducements such as food and gifts. Thus industry sponsored programs may lead to a change in decision by a prescribing physician. There is evidence to show that many physicians have been influenced by drug companies by virtue of gifts and food that may be given to physicians. Medical professionals should therefore make very sober and unbiased ethical decisions while handling a case of conflict of interest. Futility This is a concept that has been a significant topic as far as discussions pertaining medical ethics are concerned. Questions arise as to what measures should be taken if there is no hope that the patient is ever going to survive, but inspite of this, relatives still press on advanced care. Futility has been defined by articles as a situation which involves a patient having like 1% chance of living. Advanced directives may include durable attorney powers and living wills for health care. In several cases, the wishes expressed by the patient are documented in the directives given and this gives a provision of framework which can act as a guide to relatives and health professionals, in making the right decision for the incapacitated patient. Expressed wishes that are undocumented can still be used and assist in making when the advanced directives are missing. Substituted judgments is the idea that a close relative can give consent as to the way a patient should be treated if the patient is incapable or unwilling to consent themselves. Physician-Patient relationship Inspite of all the above issues discussed above, medical practitioners have always recognized that the healthy well being of their patients, depends so much on upon the collaborative effort of both the patient and physician. This part is therefore so important that it must form the conclusion of our discussion. Patients usually share with their physicians the task of taking care for their health. The relationship that exists between a physician and a patient is of so much benefit to the patients especially when they entrust health professionals with information regarding the history of their medical condition the best way they can, and thus make it possible and easy for the medical professional to work with them in an atmosphere of mutual respect. Medical practitioners can greatly contribute to this important alliance by working as servants and advocates of their patients, and making ethical decisions that foster the following rights; The right of the patient to receive or get information from the health care professional and discuss with his/her costs and risks of appropriate manner of treatment alternatives available. Patients should be guided by their physicians who should arrive at the right decision after listening to what the patient has to say. The physician therefore should arrive at the most optimal and suitable route of action so as to benefit the patient. The patient should be given summaries and copies regarding their medical records, have their queries responded to, be informed of any possible conflict of interest their physicians could be having and receive independent opinions from other professionals. The patient is entitled to making a decision as to the healthcare recommended by his/her medical professional. Patients also have a right to refuse or accept any decision made by the physician regarding their treatment. A patient is entitled to the right of courtesy, dignity, respect, timely attention and responsiveness to his/her needs. The patient is entitled to continuity of health care-a physician cannot just decide to discontinue treating a patient as far as further treatment is indicated medically, without informing and giving him/her reasonable help and enough opportunity to look for alternative health care arrangements. The patient is entitled the basic right of having enough medical care while sick. Physicians all over with the help of the society should be able to work towards achievement of this noble goal. Fulfilling this right of care is dependent on the society’s provision of the required resources so as not to deprive any client at all of the necessary health care due to lack of resources for payment of health services. Medical practitioners should keep on with their traditional responsibility of assuming part of the burden of the medical care for those not privileged enough to afford basic health care. Medical professionals should act as advocates for their patients while dealing with third parties where appropriate. The patient is entitled to privacy and confidentiality-the medical practitioner may not at any given time reveal private information or communication about a patient without the consent of the patient, unless if it is provided for by the law or the need to offer protection of the individual’s welfare or public interest. Thus the practice of healthcare and its embodiment in clinical encounter pertaining a physician and patient is basically more of a moral activity which arises from the importance to take care of patients and reduce their suffering. A relationship exists between a physician and patient when a physician takes care of a patient’s needs medically, and this is done by a mutual consent existing between a physician and a patient. It should be known that this relationship is usually based on mutual trust and leads to physician’s ethical decision obligating him/her to place the welfare of the patient above his/her own self-interests or obligations to any other group. It is clear that the ethical decisions made by medical practitioners are very critical to not only the healing and continued well being of the patient but also regards highly to career success. Ethical decisions should always be arrived after careful consultations and second opinion have been sought, not only from other medics but more so from the patient’s side as well. References George, P. D. (2013). Legal and Ethical Issues for Health Professionals. New York: Jones &Bartlett Learning,LLc. Stanford C. Carla, Connor. J.Valerie (2014). Ethics for Health Professionals. New York: Jones & Bartlett Learning,LLc. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion10015.page? Read More