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Updated: Oct 18 2022

Ethical Principles

  • Core Ethical Principles
    • There are 4 core ethical principles
    • Autonomy
      • respecting patients as individuals
      • honoring patient's preferences in medical care
        • the patient's preferences take priority when making medical decisions
        • therefore, the decider of decisions is patient word > living will > next of kin
        • communicate with non-English speaking patients through a professional translator
      • respecting confidentiality
    • Beneficence
      • acting in patient's best interest
      • balance autonomy and beneficence, but autonomy trumps beneficence
    • Nonmaleficence
      • "do no harm"
        • politely but firmly refuse inappropriate requests
      • do not help patients commit suicide
    • Justice
      • distributive Justice
        • governs allocation of limited resources
      • formal Justice
        • equals must be treated equally
  • Other Principles
    • Breaking bad news
      • set up the interview
      • assess the patient's perception
      • obtain the patient's invitation (i.e. permission)
      • give the patient the necessary knowledge
      • address the patient's emotions with empathetic responses
        • in cases of bereavement, being empathetic with patient families and offering to answer questions
      • in pediatric cases, both parents and patients have a right to know the diagnosis and treatment
        • group conversations can facilitate "right to know" conflicts while maintaining legal and ethical principles
    • End of life care principles include:
      • evaluate patients for hospice care if they have
        • a life limiting diagnosis
        • prognosis of less than 6 months
      • give hospice patients antibiotics and pain medications
        • treatments that enhance quality of life should be administered in hospice care
        • only treatments that sacrifice current well-being for future longevity should be avoided
      • informing patients about their diagnoses even against family wishes
    • Open-ended questions are the best way to elicit a patient history; closed-ended questions are useful for follow-up or clarification
      • motivational interviewing involves supporting patients to formulate their own goals
      • OARS principles are open-ended questions, affirmations, reflective listening, and summaries
    • Many patient encounters necessitate a combination of the above ethical principles--a few general principles include:
      • encourage open communication between patients and other treating physicians
      • attempt to preserve the patient's relationship with other health-care providers.
      • nonetheless, ensuring that the patient is receiving the best available care is always the primary priority
      • if a mistake is discovered the physician should disclose that to patient/family
      • all safety concerns should be taken seriously, even seemingly trivial ones from junior team members
    • Confidentiality
      • all patients, regardless of age, should have the option of speaking to their physician alone
      • minors (<18 years-old) generally require their parents to consent to receive treatment, with the following exceptions (in most states):
        • care for
          • sexual health (e.g. pregnancy, contraception, sexually transmitted infection treatment)
          • mental health
          • substance abuse
        • emancipated minors
        • emergencies
      • parents should be asked to leave the room so teenage patients can discuss:
    • Conflicts of interest:
      • physicians should report conflicts of interest
      • physicians can accept honoraria and be compensated for travel expenses, but cannot have assistance with slide presentations from pharmaceutical companies
    • Capacity
      • physicians can determine capacity which is the ability for the patient to understand their treatment as well as the risks, benefits and alternatives
      • competence is a legal designation and can not be determined by a physician
    • Adherence
      • extended contact with physicians through follow-up appointments increases adherance with lifestyle changes
      • barriers to medication compliance should be explored in a non-judgemental open-ended manner
      • concerning reports of medication abuse should be discussed directly with the patient
      • creating an organized written linear care plan is key to increasing medication compliance in patients
      • adopting a non-judgmental collaborative mindset is key for treating substance use disorder
      • providing helpful information in a non-judgemental way is key to addressing alternative medicine
    • Patients with a history of sexual abuse
      • physicians should first listen empathetically to the patient's feelings and concerns
      • avoid judgmental statements, over-pathologizing, or prematurely jumping to treatment
    • Medication compliance in children
      • multifaceted issue, with factors including age of patient, knowledge about disease, peer pressure, rebellion/independence, socioeconomic status, cultural issues and beliefs, and family structure
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