Principles of medical ethics

Principles of Medical Ethics - The Core Four

• Autonomy: Patient's right to make informed, voluntary decisions about their own care. Requires capacity and informed consent.
• Beneficence: Acting in the patient's best interest; promoting well-being and preventing harm.
• Non-maleficence: "First, do no harm" (primum non nocere). Avoidance of inflicting needless harm.
• Justice: Fair and equitable distribution of healthcare resources and risks.

⭐ A competent patient's right to autonomy allows them to refuse life-sustaining treatment, even if the physician believes it is in their best interest (beneficence).

Informed Consent - The Patient's Permission Slip

• A process of communication between a clinician and a patient that results in the patient's authorization or agreement to undergo a specific medical intervention.

• Core Components (📌 BRAIN):

  • Benefits: The potential positive outcomes.
  • Risks: The potential negative outcomes.
  • Alternatives: Other available options, including no treatment.
  • Implications: Consequences of refusing treatment.
  • Nature: The details of the proposed procedure.

• Patient Requirements:

  • Must have decision-making capacity.
  • Consent must be voluntary (free from coercion).

• Exceptions to Informed Consent:

  • Life-threatening emergencies (implied consent).
  • Patient waives the right to be informed.
  • Therapeutic privilege (rarely invoked).

⭐ High-Yield: A patient has decision-making capacity if they can communicate a choice, understand relevant information, appreciate the medical situation and its consequences, and reason through treatment options. This is a clinical determination, whereas competence is a legal one.

Confidentiality - Keeping Secrets Safe

• A core tenet of medical ethics and the physician-patient relationship. Governed by the Health Information Portability and Accountability Act (HIPAA), which protects patient health information (PHI).
• Information is shared only with the patient's explicit consent, or in specific, legally mandated situations.

• Exceptions permitting/requiring disclosure:
  • Patient grants permission.
  • Suspected child or elder abuse.
  • Threat of harm to others (Tarasoff "duty to protect").
  • Reporting specific communicable diseases (e.g., TB, STIs).
  • Valid court orders.
  • Impaired drivers or other operators affecting public safety.

⭐ Tarasoff v. Regents of U. of California established the "duty to protect." This allows physicians to warn a potential victim of a patient's credible threat, overriding confidentiality.

Ethical Scenarios - Tricky Situations

• Treating colleagues, friends, or family: Avoid whenever possible. It compromises objectivity and may lead to substandard care. Transfer care to a neutral colleague.
• VIP patients: Treat with the same standard of care as any other patient. Avoid special treatment which can paradoxically lead to worse outcomes.
• Patient gifts: Accept small, inexpensive gifts. Politely decline large or monetary gifts that could create a conflict of interest or imply a quid pro quo.
• Non-adherent patients: First, explore the reasons (e.g., cost, side effects, misunderstanding). Use motivational interviewing. Only consider terminating the relationship as a last resort.

⭐ When a patient offers a significant gift, the physician should gently refuse, explaining that the best gift is the patient's recovery and trust. Document the interaction.

High‑Yield Points - ⚡ Biggest Takeaways

• Autonomy is the patient's right to choose or refuse treatment, a foundational principle.
• Beneficence (acting in the patient's best interest) must be weighed against Non-maleficence (do no harm).
• Justice refers to the fair allocation of healthcare resources.
• Informed consent is a process involving discussion of risks, benefits, and alternatives.
• Confidentiality is key but can be breached to prevent imminent, serious harm to others.
• Decision-making capacity is a clinical assessment and is task-specific.