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Updated: Oct 21 2022

Ethical Principles

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


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