Updated: 3/29/2022

Ethical Principles

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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"  
    • 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 
  • 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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