Intro In Medical Ethics
Intro in Medical Ethics What is medical ethicsBasic principlesControversial issuesEthics for clinical technologists17.6.0 Intro in Medical EthicsUnit C 17.6 Trends in Medical Research EthicsModule 279-17-C Regulations, Standards and Ethicsdr. Chris R. Mol, BME, NORTEC, 2015
Moral principles in Biomedical EthicsA common framework used in the analysis of medical ethics is the "four principles" approach.It recognizes four basic moral principles, which are to be judged and weighed against each other,depending on the precise case. The four principles are: Beneficence– to act in the best interest of the patient.Non-maleficence– "first, do no harm“Autonomy– the patient has the right to refuse or choose their treatment.Justice– who gets what treatment (fairness and equality).Other values that are often discussed include: Respect for persons – the patient (and the person treating the patient) have the right to betreated with dignity. Truthfulness and honesty– the patient deserves to know the whole content about the illnessandtreatment (including ‘informed consent’)Values such as these do not give answers as to how to handle a particularsituation, but provide a useful framework for understanding conflicts. dr. Chris R. Mol, BME, NORTEC, 2016Intro Medical Ethics
Non-maleficence: ‘first, do no harm’Non-maleficence ‘first’ is based on the notion that it is more important not toharm than to do good. Be on the safe side!It is important to know how likely it is that a treatment will harm a patient.So a physician should not prescribe medications (or otherwise treat thepatient) unless s/he knows that the treatment is unlikely to be harmful; or atthe very least, that patient under-stands the risks and benefits, and that thelikely benefits outweigh the likely risks.In practice many treatments carry some risk of harm. In some circumstances, e.g. in desperate situationswhere the outcome without treatment will be grave, risky treatments that stand a high chance of harmingthe patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of nonmaleficence is not absolute, and balances against the principle of beneficence (doing good), as the effectsof the two principles together often give rise to a double effect.If benefit equals harm, do not intervene dr. Chris R. Mol, BME, NORTEC, 2016Intro Medical Ethics
Respect for autonomyAutonomy is where the patient has the right to refuse medical treatment orchoose a medical treatment. Autonomy is the basis for the requirement of‘informed consent’ regarding treatments.Without the ethical principle of Autonomy, the principlesof Non-Maleficence and Beneficence would lead to apaternalistic approach: the doctor decides what is‘ethical’.Because of this principle, physicians should disclose information andhelp patients deliberate.A person's autonomy may be justifiably restricted for several reasons: the person is incapable of making informed decisions. Respecting autonomy is less important thanacting in the best interest of the patient. individual autonomy is constrained by the needs of other individuals or society at large. an individual is not free to act in ways that violate the autonomy of other people, harm others, orimpose unfair claims on society's resources dr. Chris R. Mol, BME, NORTEC, 2016Intro Medical Ethics
JusticeJustice is where patients are treated impartially, without bias on account ofgender, race, sexuality, wealth and etc. Justice focuses on who gets medicaltreatment with specific scarce medical resources.For example, one of the first instances to allocate a scarce medicalresource was in the 1960s with the availability of dialysis for people inchronic kidney failure. Since the demand exceeded the supply becausedialysis was expensive and not accessible on a large scale, it meant not allpeople who needed it could receive it. So the principle of Justice wasapplied.You are a physician working in an Intensive Care Unit with a capacity of fiveHow to set priorities forbeds, four of which are occupied. You receive a call from Emergency wheredeciding whether we want CTthey have two patients needing ICU admission. The mother of one of thosescanners, dialysis equipment,patients, whom you know, pleads with you to save her young son. The otherdental chairs or theatrepatient, as you find out later is a foreigner with no relatives in the country.equipment ?What would be the right action in this case? dr. Chris R. Mol, BME, NORTEC, 2016Intro Medical Ethics
Truthfulness and HonestyTruthfulness and Honesty builds on Autonomy to leadto ‘informed consent’Informed consent refers to the idea that a person must befully informed about and understand the potential benefitsand risks of their choice of treatment. An uninformedperson is at risk of mistakenly making a choice not reflectiveof his or her values or wishes.The process of obtaining consent, or the specificPatients can elect to make their own medical decisions,legal requirements, will vary from place to placeor can delegate decision-making authority to anotherparty.If the patient is incapacitated, laws around the world designate different processes for obtaining informedconsent, typically by having a person appointed by the patient or their next of kin make decisions for them.The value of informed consent is closely related to the values of autonomy and truth telling. dr. Chris R. Mol, BME, NORTEC, 2016Intro Medical Ethics
Conflicts between the principlesAutonomy can come into conflict with Beneficence when patientsdisagree with recommendations that healthcare professionalsbelieve are in the patient's best interest.When the patient's interests conflict with the patient's welfare,different societies settle the conflict in a wide range of manners.In general, Western medicine defers to the wishes of a mentally competent patient to make their owndecisions, even in cases where the medical team believes that they are not acting in their own bestinterests. However, many other societies prioritize beneficence over autonomy. A patient in a Nursing home has no ability to find food, prepare it or bring it to her mouth, buthas ability to swallow. Should she be fed? What, if a patient does not want a treatment because of, for example, religious or culturalviews? What if parents do not want such treatment for their children? What, if the patient wants an ‘unnecessary’ treatment, as can be the case in hypochondria orwith cosmetic surgery. dr. Chris R. Mol, BME, NORTEC, 2016Intro Medical Ethics
Controversial issue: Ending medical treatmentModern technology has complicated the application of theBeneficence principle. up to what point do you use technology (e.g. aventilator) to keep a very ill patient alive who hasmassive brain damage or even no brain function left. In some situations, it is technically possible to continueventilating the patient for a very long time, causing theheart to continue pumping and to keep ‘the body’ alive. The traditional criterion for death is ‘the irreparablecessation of heartbeat, respiration and blood pressure’. These days, brain death is often considered death. dr. Chris R. Mol, BME, NORTEC, 2016Changes in Research Ethics
Controversial issue: EuthanasiaDue to modern healthcare, people sometimes get very diseased and demented. They can suffer a lot.Often, such persons want to die, but are not able to accomplish this themselves.Is it ever allowed to help such a person dying ?Passively (letting a patient die): withdrawing life support (e.g. ventilation,intravenous feeding, medical drugs)Actively (helping a patient to die): giving a deadly injection or potionIf the answer is yes, under what conditions would that be?Strict conditions in the Netherlands for active euthanasia include:it should be requested repeatedly by the patient, unbearable suffering without end, two medicaldoctors, How about giving a terminally ill patient a dose of pain-killing morphine, which can be expected to hastendeath ?dr. Chris R. Mol, BME, NORTEC, 2016Changes in Research Ethics
Ethics for Clinical Engineering ProfessionalsA lot of information can be found on the internet regarding Ethics for BioMedicalTechnologists and related professions. For example:The American College of Clinical Engineering (ACCE) defines a clinical engineer as“A professional who supports and advances patient care by applying engineeringand management skills to health care technology.”ACCE amplifies this definition in its seven-point code of ethics, as follows:1. Prevention of injury in the clinical environment2. Accurate representation of the clinical engineer’sknowledge, level of responsibility, education, authority andexperience3. Revelation of conflict of interest4. Protection of confidential information5. Improvement of patient care delivery6. Cost containment by technology utilization7. Promotion of the profession of clinical engineering dr. Chris R. Mol, BME, NORTEC, 2016“It is not ethical to allowclinical users to work withan unsafe device.”Intro Medical Ethics
ENDThe creation of this presentation was supported by a grant from THET:see https://www.thet.org/
Intro in Medical Ethics Module 279-17-C Regulations, Standards and Ethics Unit C 17.6 Trends in Medical Research Ethics 17.6.0 Intro in Medical Ethics dr. Chris R. Mol, BME, NORTEC, 2015 What is medical ethics Basic principles . PowerPoint-presentatie Author: Chris Mol
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