The fundamental responsibility of a health care professional such as a doctor is to promote and restore health, prevent illness and alleviate suffering. Every life should be respected, and the dignity of the patient should be respected.
Before an ethical dilemma can be resolved, it is important that one has a firm grasp of all the facts including the patient’s diagnosis, prognosis, what the patient has been told and what they understand, and what the patient’s values are.
Where the law establishes a clear course of action, legal obligations should be followed. However, in situations where there is no clear legal requirement, the course of action may be unclear and hence the issue becomes an ethical one. Healthcare ethics is a difficult but interesting area where moral principles, medicine and science interact.
Care and compassion are important, as are the moral principles of:
- Beneficence: healthcare should be of benefit to the patient- their health, welfare, comfort.
- Autonomy: all decision-making should ultimately be the patient’s. Informed consent is important in this regard.
- Non-maleficence: avoidance of harm to the patient.
- Justice: a patient should receive reasonable, dignified and equal access to medical care.
Some areas where clinicians are faced with dilemmas pertaining to healthcare ethics include:
- Balancing safety of health care with efficiency and limited resources.
- Improving access to healthcare.
- Addressing end of life issues in the context of increasing average life expectancies and aging populations.
- Access to medications which can be costly but life saving.
- Allocation of limited donor organs.
- Patient confidentiality.
- Disclosure of medical errors.
Many ethical dilemmas may have medico-legal implications. It is important that a clinician practises evidence-based medicine, is aware of their legal duties to a patient, and provides a reasonable standard of care that would hold up to professional review should there be any accusations of medical negligence.