Published on 07/02/2015 by admin
Filed under Anesthesiology
Last modified 07/02/2015
This article have been viewed 1353 times
Keith H. Berge, MD
Medical practice is a complex undertaking, fraught with ambiguity and uncertainty. A clinician is often forced to choose between alternate courses of action when there is little in the way of guidance for his or her actions. How, then, is a decision to be reached in the face of such ambiguity, especially if the decision creates a moral conflict for the physician? Although medical ethics focus on the “oughts” and “shoulds” of patient care, the study of medical ethics will usually fail to reveal a single “right” course of action. However, clarification of the relevant issues of the case at hand will often allow a decision to be reached in a manner that is not capricious or based on a visceral reaction to the clinical facts.
Medical ethics have been an integral part of the practice of medicine for ages. Perhaps the most famous code of ethics is the Oath of Hippocrates, which states many of the principles that still guide the modern-day physician. As modern medical practice has evolved, many ethical dilemmas have become manifest as a result of advances in technology. This has forced a rapid evolution in medical ethics from the relatively simplistic codes that have guided the “virtuous” physician for centuries. Hand in hand with this evolution has been an evolution in the laws regarding a vast array of complex biomedical issues, such as assisted suicide and euthanasia, abortion, surrogate motherhood, genetic testing of minors, withdrawal of artificial nutrition and hydration, and allocation of scarce resources. No broad consensus exists on most of these topics, reflecting the wide range of values within our pluralistic society.
The principles of autonomy, beneficence, nonmaleficence, and justice, expounded on at length by Beauchamp and Childress, are cornerstones of current ethical writings.
Autonomy is derived from the Greek root words autos (self) and nomos (rule, governance, or law). The autonomous person retains personal rule of the self while remaining free from both controlling interferences by others and personal limitations, such as coercion or inadequate understanding, that prevent meaningful choice. For example, courts and medical ethicists have long agreed that any patient with the capacity to understand the consequences of her or his actions has the right to reject any medical care, even “lifesaving” care, for herself or himself.
Beneficence is an obligation to help others further their important and legitimate interests. This requires the removal of harm as well as the provision of benefit and an effort to balance the benefits and harms of alternate plans of action so as to maximize the benefit. An example of this is the obligation for a physician to render emergency assistance when necessary.
Nonmaleficence is an obligation not to inflict evil or harm on others. It is clearly associated with the maxim primum non nocere, “above all, do no harm.” The Hippocratic Oath addresses the duty to both nonmaleficence and beneficence with the statement, “I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them.”
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