Ethical Principles - Stats - Medbullets Step 2/3

Core Ethical Principles

There are 4 core ethical principles
Autonomy
- respecting patients as individuals
- honoring patient's preferences in medical care
  - the patient's preferences take priority when making medical decisions
  - therefore, the decider of decisions is patient word > living will > next of kin
- respecting confidentiality
  - Exceptions include: danger to self or others, verbal or written consent from patient to share their information with another party, notifiable infectious diseases, elder/child abuse
- pregnant patients may decline treatment, regardless of potential harm to the fetus
  - once the child is born, its parents cannot decline to treat the child for life-threatening conditions
Beneficence
- acting in patient's best interest
- balance autonomy and beneficence, but autonomy trumps beneficence
Nonmaleficence
- "do no harm"
- physician-assisted suicide is considered unethical
Justice
- distributive Justice
  - governs allocation of limited resources
- formal Justice
  - equals must be treated equally

Other Principles

Health proxies and power of attorney
- patients may designate a health proxy or power of attorney that can make decisions for them if they are incapacitated
- if patients do not designate a proxy, typically family is consulted
- trainees may perform procedures on deceased patients for educational purposes with permission of the proper patient proxy or family member
Breaking bad news
- set up the interview
- assess the patient's perception
- obtain the patient's invitation (i.e. permission)
- give the patient the necessary knowledge
- address the patient's emotions with empathetic responses
Patients (in general) have a right to know their diagnoses
- if patient's do not want to know the diagnosis always assess why rather than merely obeying first
Open-ended questions are the best way to elicit a patient history; closed-ended questions are useful for follow-up or clarification
Many patient encounters necessitate a combination of the above ethical principles--a few general principles include:
- encourage open communication between patients and other treating physicians
- attempt to preserve the patient's relationship with other health-care providers.
- nonetheless, ensuring that the patient is receiving the best available care is always the primary priority
- if a mistake is discovered the physician should disclose that to patient/family
- for difficult patients demonstrate empathy and make a plan together so they feel involved
Privacy and the doctor-patient relationship
- all patients, regardless of age, should have the option of speaking to their physician alone
- this includes adolescents, spouses, and elderly adults
- inappropriate patient requests should be politely denied since it can encourage future inappropriate behavior
Conflicts of interest:
- physicians should report conflicts of interest
- physicians can accept honoraria and be compensated for travel expenses, but cannot have assistance with slide presentations from pharmaceutical companies
Capacity
- physician's can determine capacity which is the ability for the patient to understand their treatment as well as the risks, benefits and alternatives
- competence is a legal designation and can not be determined by a physician
Pediatric considerations
- parents cannot refuse life or limb saving treatment for their child
- with the exception of life-threatening treatment, parents have autonomy to make medical decisions for their children
  - this includes vaccinations