Ethical frameworks for decision-making

Core Principles - The Big Four

• Autonomy: The patient's right to make informed, voluntary, and competent decisions about their own medical care.

  • Foundation for informed consent, truth-telling, and confidentiality.
  • Respects individual values, even if they conflict with the physician's recommendations.

• Beneficence: The duty to act in the best interest of the patient; to promote their well-being.

  • Focuses on providing a net benefit to the patient.
  • Core concept: "Do good."

• Non-maleficence: The duty to avoid causing unnecessary harm to the patient.

  • "Primum non nocere" or "First, do no harm."
  • Requires balancing the potential benefits against the risks of any intervention.

• Justice: Fair and equitable distribution of healthcare resources and treatment.

  • Treating similar cases with similar care, regardless of patient characteristics.
  • Applies to both individual patient encounters and societal resource allocation.

⭐ Ethical dilemmas frequently arise from conflicts between these principles, most commonly pitting patient Autonomy against physician Beneficence (e.g., a patient refusing a life-saving treatment).

Ethical Theories - Duty vs. Outcomes

• Deontology (Duty-Based)

  • Focuses on inherent rightness/wrongness of an act, not its consequences.
  • Associated with Immanuel Kant.
  • An act is moral if it follows a universal rule (e.g., "do not lie," "do not steal").
  • The physician's duty to the individual patient is paramount.

• Consequentialism (Outcome-Based)

  • Judges an act based on its results.
  • Utilitarianism: A common form; seeks the "greatest good for the greatest number."
  • An action is moral if it maximizes positive outcomes and minimizes harm for the largest group.

⭐ In clinical dilemmas, Deontology prioritizes individual patient duties (e.g., confidentiality), while Utilitarianism might justify breaking that duty for a greater public good (e.g., warning others of a direct threat).

Practical Application - Consent & Capacity

• Informed Consent: A process ensuring patient voluntarism & autonomy. Not just a form.
  • 📌 BRAIN: Benefits, Risks, Alternatives, Implications of No treatment.
  • Exceptions: Emergencies, waiver, therapeutic privilege (rare), incapacity.
• Decision-Making Capacity: A clinical assessment; competence is a legal term.
  • Assessed if a patient refuses recommended treatment or makes questionable decisions.
  • Requires the patient to:
    • Communicate a choice.
    • Understand relevant information.
    • Appreciate the situation & consequences.
    • Reason about treatment options.

⭐ A patient with capacity has the right to refuse any medical treatment, including life-sustaining therapy, even if it results in death. This is a cornerstone of patient autonomy.

High‑Yield Points - ⚡ Biggest Takeaways

• Beneficence (act in patient's best interest) and Non-maleficence (do no harm) are core duties.
• Autonomy respects a patient's right to make informed decisions about their own body.
• Justice ensures fair allocation of healthcare resources and equitable treatment.
• Informed consent is a process, not just a signature; requires decision-making capacity.
• Confidentiality is paramount but can be breached to prevent serious harm to self or others.
• Ethical dilemmas often involve conflicts between these fundamental principles.