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