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 Obtain a thorough and non-judgemental history in cases of domestic violence 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