Making ethical decisions in medicine

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Consider these few scenarios…

– With two patients fighting for their lives, how do you decide whether to save the life of a patient in the prime of his life or a baby who is just starting out in life?
– Is it ethical to pull the plug on a life support machine of a patient when there is no hope left or should they be kept on life support indefinitely?
– Should you advise a pregnant couple to go in for an abortion because there were marked abnormalities that showed up in the sonogram or would that be unethical?

These and other questions like these have given doctors all over the world many sleepless nights. Cultural and religious differences make it even more complicated and in many ways, so does medical advancement. While the potential of using stem cells, genetics, life support machines and other medical discoveries hold out a lot of hope, they can also suddenly create ethical dilemmas that were unheard of even a few years ago.

So what’s right and what’s wrong? How do you know that you are making an ethical decision? Doctors who find themselves in these situations use the three fundamental principles of medical ethics to help them make the right decision:

Respect for the patient’s autonomy

Autonomy refers to a person’s capacity to think, make a decision and act on their own free initiative. If the patient is coherent and of an age where they can understand the consequences, physicians and family members are obligated to provide all information to the patient so they can come to their own decision. In this case, an adult patient’s decision must be upheld even if it appears medically wrong.

Autonomy of a patient may not be applicable to very young children or geriatric patients who are not able to grasp the implications of their decisions.

Beneficence

Beneficence means advocating what is best for the patient. What is best may differ slightly in different scenarios. The ultimate decision will depend on the combination of the health professional’s judgment and the patient’s wishes (patient autonomy).

Beneficence takes into consideration how much pain the patient is in, their quality of life, their physical and mental suffering and the risk of potential disability or death. Sometimes, this may involve not proceeding with any treatment at all, if it is decided that any type of medical intervention would produce minimum or no benefit.

Non-maleficence

Non-maleficence essentially means do no harm. However, it is an accepted fact that there is some degree of risk with most medical treatments. What this principle does is it acts as a reminder to doctors to ponder the likelihood of any harm being done, especially when there is no sure cure.

For example, before recommending preventive care or immunizations to healthy individuals, doctors need to ask, ‘Do the benefits outweigh potential harm’?

There is also the Justice principle that holds that all patients in similar circumstances should have access to the same level of care. However, when resources are limited and not everyone can receive the treatment they require, healthcare providers must prioritize. This can be one of the most difficult dilemmas for any doctor. How do you decide who to treat first?

Making ethical decisions can be one of the most challenging aspects of being a doctor. You will have to weigh several factors very carefully before arriving at a decision that you are fully convinced is the right one.

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Gap Medics provides year-round hospital work experience for people aged 16 and over. Our shadowing placements offer a unique insight into the work of doctors, nurses, midwives and dentists – helping students to focus their career aspirations before embarking upon medical training.

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