Ethics are the principles that should guide doctors and other health care professionals in their work and decision-making
☛ they are not laws but guiding principles; some things may be legal but are not ethical.
☛ they apply to all medical care but assume greater importance when caring for people at the end of life.
☛ unlike cultural issues that differ from country to country, the same ethical principles apply everywhere.
There are four main principles of medical ethics
Beneficence — is to produce benefit, to do good, to always act in the best interests of the patient
☛ whatever is done or said must be for the patient’s good
☛ includes being honest with patients, which in nearly all circumstances will be of benefit to the patients
☛ patients should not be subjected to unnecessary investigations
☛ patients should not be subjected to unnecessary or futile therapies
☛ applies not only to physical good but also to psychological, social and existential well-being
☛ must be distinguished from paternalism (‘doctor knows best’)
Non-maleficence — is to minimise or do no harm
☛ whatever is done or said must not harm the patient, physically or psychologically
☛ includes being honest with patients; lying to patients or telling only part of the truth will very probably cause harm
☛ for every intervention, the potential benefits must be weighed against possible adverse effects
☛ treatments should not be prescribed unless there is a strong chance they will help the patient and only a small chance of unpleasant adverse effects. In palliative care, there is no place for the prescription of placebo.!prescribing should aim to produce the minimum of adverse effects.
Autonomy — acknowledges patients’ rights to self-determination, without prejudice
☛ treatments can only be given with patients’ informed consent
☛ it is the patients’ right to decide what treatments they do or do not wish to have
☛ patients have a right to be fully informed in order to make decisions.
☛ heath care professionals have an obligation to provide honest and complete information when it is requested. Opportunities must be given for them to ask questions and show that they understand what is being suggested to them
☛ applies not only to medical treatments but also to matters such as where they receive care, and who shall provide their care
Justice — refers to the equitable allocation of health care resources according to need
☛ not according to wealth, class, creed or colour
☛ unfortunately, observation of health care around the world shows much lack of justice
☛ many treatments are only available to the rich, or those with influence and power, or those articulate enough to ask for something better
☛ in some countries morphine is available only if the patient can afford it
☛ in some countries even palliative care has to be paid for and lack of money may mean dying in pain, possibly alone, without any dignity
In Clinical Practice
☛ situations arise where there is apparent conflict between different principles
☛ in assessing which principle is the more important
- - give priority to what is in the best interests of the individual patient
- - weigh the possible benefits against the potential adverse effects for each proposed therapy
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://web.archive.org/web/20210122105526/https://hospicecare.com/uploads/2013/9/The%20IAHPC%20Manual%20of%20Palliative%20Care%203e.pdf
