The Four Ethical Pillars of Medicine

by Victoria Toh

In the medical world, the constant challenge of what is morally right and the ethics behind each choice you make as a doctor is a hot topic within the news. To help with these sticky situations, the NHS has published four ethical pillars to aid these decisions; beneficence, non-maleficence, autonomy and justice. In short summary; beneficence is to work for the patients most benefit, non-maleficence is to do no harm to the patient or others in society, autonomy gives the patient the sole decision-making and justice, to provide a fair distribution of resources and equal access. These four NHS pillars of ethics help to provide a guideline to approaching a situation but there are times where these same principles lock you into a nail-biting dilemma. A case recently in the news has shown just how complex these principles are when choosing what to do.

The case challenges the duty of care versus patient confidentiality and has been brought to hearing to The High Court in London. The hearing hopes to clarify the duty of doctors to disclose confidential information about a patient’s hereditary disease to relatives. The woman involved, who had accidentally learnt of her father’s Huntington’s disease, is suing three NHS trusts for not passing the information to her.  She claims that had she had known earlier, she would have aborted her child. Later testing found that she had the gene for Huntington’s disease and her daughter, not tested yet, has a 50% risk of inheriting the gene. This fatal disorder which damages nerve cells in the brain usually shows symptoms and develops between the age of 30 and 50. The woman is currently in her 40s. From this, she told the court ‘the future is absolutely terrifying’, posing the question of whether the doctors were wrong to not tell her.

The father who passed away from this disease was the one who had refused to tell his daughters and told the doctors not to pass on the information of his disease. He was frightened that his daughter may have got upset or aborted the child. The doctors were challenged upon the patient’s autonomy to respect his decision and his confidentiality or whether to break this and tell his daughter, who is now suffering from this condition.  The claimant is suing the trusts for more than £300,000 for damages and claims that the doctors should have told her of the condition that affects both her and her daughter even though she is not a patient. Her case was originally thrown out by the High Court Judge but later decisions overturned and ruled the case to go ahead. Faced with the challenges of respecting a patients decision and the competing to tell the people that may be affected, this case shows just how difficult ethics is and that there is almost no correct way. In this case, the woman and her daughter’s quality of life and wellbeing should have been considered as they were to be the most affected from this discovery of the condition and whether this outweighs the father’s decision is questionable but most will probably agreeable. There has been no further advancement thus far but the complexities of this sensitive issue in respect to the duty of care and confidentially has rocked the medical ethics principles and questioned the current system and structure in place.

Are they wrong for not telling her?

To read the full article: https://doi.org/10.1136/bmj.l6600