by Saanvi Ganesh
Medical ethics defines the values and principles that ensure the best treatment possible for each individual patient. It aids analysis of clinical medicine and related scientific research and is referred to by health professionals in any case when making decisions, whether though or not, on patient treatment. Medical ethics dates back to the 5th century BCE with the Hippocratic Oath being the oldest code of conduct for doctors, however the term 'medical ethics' was only coined in 1803 by English physician Thomas Percival. The Hippocratic Oath summarises the basic principles of medical ethics, which are often referred to as the 'Four pillars of medical ethics'. These are: Beneficence, Non-Maleficence, Justice and Autonomy (in no particular order).
Hippocrates' Oath glosses over the last pillar, autonomy, which has become more important and prevalent as centuries passed. Autonomy is the patients' right to refuse or carry on with treatment; medical professional cannot force or pressure the patient into taking treatment, where deemed to have capacity to make informed decisions. But when are the patients deemed unfit? The Mental Capacity Act (2005) lays out a two-step test of capacity: does the person in question have an impairment of their mind or brain as a result of an illness or other factors like alcohol/drug use? And does this impairment mean the person is unable to make a specific decision? Sufficient time should be given to the patient to understand the information and conclude where they can. A patient may also be unable to make some decisions but not others. How is this possible?
The ability to decide lands on three points: whether the person understand the relevant information given, whether the person can retain this information and whether the person can weigh up that information as a part of coming to a decision. From these points we can see how a person may be able to understand information for certain decisions but not others, and it is important that the patient can understand enough of the relevant information. It is the duty of a doctor to help their patient to make as many decisions as possible themselves, by providing the relevant information, other methods of communication or by selecting the best location and time for a patient to make a decision. Autonomy also respects any wishes for passive euthanasia, however this requires convincing proof which may be in the form of a signed DNR (Do Not Resuscitate) document. The argument on whether this is morally correct or not is a different debate, which I will not be covering in this article.
In the case of a patient that has been proven to be unable to make their own decisions, the healthcare professional in charge must decide, often after consulting next of kin but next of kin are not legally authorised to make decisions on the patient's behalf, based on what is in the person's best interests. This is unless the person has made an Advance Decision, in which case the healthcare professionals must decide if the Advance Decision is valid and must follow it. This is also unless the person has appointed an LPA, who would make the decision in the person's best interests.
The question of best interests links to the second and third pillars, beneficence and non-maleficence. Beneficence refers to promoting the well being of others and taking actions with the best outcome for patients in mind. Non-Maleficence is a condensed form of the Hippocratic Oath, meaning to do no harm. Both often go 'hand in hand', however there are instances when these two pillar conflict. For example again, in the case of passive euthanasia. Through the lens of non-maleficence, passive euthanasia or any euthanasia is simply wrong - it is a sin, because it harms the patient. If the case is viewed from the point of beneficence, we can start to make a judgement on whether this will be the best outcome for the patient. In a case where euthanasia is even considered, the competent patient must first actively ask for it, for this to happen that patient would have to be in considerable pain, preferring to die rather than live with the pain. So, in a case where living causes more pain than dying, living causes more harm than dying and there is no alternative, if a patient asks not to be treated, would it not be the best outcome to let nature take its course? In this case it would now comply to both pillars because by keeping the patient alive, they are harmed.
The last pillar, justice, is the question of fairness and compatibility with the law. It means that no patient is unfairly disadvantaged when accessing healthcare. It is the most difficult to implement - the NHS has a limited amount of resources which have to be distributed fairly. If one patient or group of patients is prioritised due to the type of illness, it can be argued that it means the access of another patient or group of patients is limited. An example of this can be seen on the news today, with the debate on who should get Coronavirus vaccinations first. Should it be the healthcare workers or the elderly and vulnerable?
These four pillars are important and good standards for healthcare professionals to adhere to, but they are not rigid in their application, there have been countless cases where each pillar conflicts another and the best possible route for treatment has to be decided by considering each viewpoint in turn. The knowledge and implementation of medical ethics also allows healthcare professionals to work with a clear conscience.
References:
https://www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/justice/
https://www.pbs.org/wgbh/nova/article/hippocratic-oath-today/
PGM Podcast 001 Four Pillars of Medical Ethics | PostGradMedic
Comments
Post a Comment
Comments with names are more likely to be published.