Ethics in Medicine - Ananya Gupta

Ethics in Medicine

Ananya Gupta

“Ethics” as a general term is concerned with the studying and build up of a coherent set of “rules” or principles by which people should live. It is the social value which binds the society by uniform opinion/consideration and enables the society to decide what is wrong and what is right. It is the science of morale concerning principle of human duty in the society.

Ethics in medicine often refers to examining a medical problem, and providing a solution through either facts and logic, or the patient’s or doctor’s values. Medical ethics differs from morality. Ethics is based on values and reasoning, and it uses persuasion to get its message across, whereas morality involves adhering to a specific belief system or code of conduct. There are constant changes in what is deemed to be ethical, which is why there is never a single right answer, and the best course of clinical action may be subjective. There are four pillars of medical ethics: beneficence, non-maleficence, autonomy, and justice.

Beneficence (to do good) is the idea that a medical practitioner has the moral duty to carry out treatment that would factually be in the patient’s best interest. It is mainly concerned with the circumstances, and the patient’s preference or expectations (known as patient-centric care). This specialized focus on the individual is important, as it often leads to the best care.

Non-maleficence (to do no harm) states the of a medical practitioner having the duty to do no harm or allow harm to be caused to a patient due to neglect. Although it may seem similar to beneficence, it has two major differences. Firstly, it has the understanding that if a treatment causes more harm than good, then it shall not be considered. This opposes beneficence, where all treatments are considered, and then decided by patient preference. Secondly, non-maleficence is an uninterrupted clinical practice and a duty that should be constantly carried out, in contrast to beneficence, which is individual-based, specialized treatment.

Autonomy (to give the patient freedom where able) means that the patient is given the responsibility to make their own decision for their treatment or outcome. Along with this comes the idea that a medical practitioner must not impose treatment on an individual no matter their professional opinion, except in cases where the patient is deemed unable to make their own ‘autonomous’ decision. Despite this, people often defer their treatment decision to the doctor, however at times it is important that the patient is actively involved. An interesting idea of autonomy is voluntary active euthanasia being ethically justifiable. Technically if a patient is competent, they should have the right to choose if, when and how they will die.

In medical ethics, justice (to ensure fairness) is the principle that when making a decision whether a certain path is ethical or not, it is important to consider its compatibility with the law, the patient’s rights, and whether or not it’s fair and balanced. This also means that no one shall be unfairly disadvantaged when it comes 14

to healthcare. Just like autonomy, justice can also support euthanasia, as it asserts that it is unjust to deny patients the opportunity to end their pain.

Although these are the main pillars, ethical values are not limited to just these four principals. There are other important aspects to consider, for example honesty, transparency, and showing respect for the patient as well as their own values.

A medical ethics concept to consider is consequentialism. It is an ideology that states the morality of an action is dependent purely on its consequences. Basically, if the action has an overall benefit, then the action itself does not matter. The two key components of consequentialism are the probability of an outcome occurring, and the value of that specific outcome. Although consequentialism is a broad ethical theory, there are many forms of it, for example welfare consequentialism (or welfarism). This maintains the idea that the right act is the act that maximises well-being. An example of welfarism is utilitarianism. This moral theory that focuses on the overall balance of positive and negative effects of a healthcare professional's actions. All actions are considered on the basis of consequences, not on the basis of fundamental moral rules and principles or with regard to the action’s traits. In short, it instructs a person to choose the action which maximises utility. ‘ utility ’ in this circumstance has traditionally been defined in terms of happiness or the patient’ preference satisfaction.

Just like consequentialism, deontology is another medical ethics concept, however there is an important contrast. Deontology states that the correct course of action depends on what the medical professional’s duties and obligations are. This supports the idea that the morality of an action is based on whether or not one follows To compare these concepts, studies have shown the association of deontological inclinations with empathy, religiosity, and perspective-taking, while moral concern and reduction in the cognitive load being associated with utilitarian inclinations. Although they may provide completely different outcomes, utilitarian and deontological perspectives have their own importance in medical ethics. This is why a balance between these two ideologies would improve the overall ‘ethical’ viewpoint of any certain medical practice.

In conclusion, medical ethics is not just a thought process. It also involves people skills, such as gathering the facts needed to make a decision as well as the addition of other principles. The world of medical ethics continues to see a conflict between what could pass as the ‘best’ idea. The prime example of euthanasia in medical ethics presents the dilemma of granting a person’s wish to die, as opposed to prolonging their life with medical treatment. A conflict like this may never be overcome, no matter the action of the ‘right’ objective view. A physician’s job is to carry out all possible medical treatments in attempt to prolong a person’s life, however these treatments may be deemed unethical due to the patient’s suffering, as well as the ignorance of their own opinion of their body. This is just a single example of the complications of ethical theory in medicine.