What is Medical Ethics ?

A pure scientist, simply observing medical phenomena, would have a pragmatic attitude about life, sickness, and death. Science needs an ethical framework to make it humane.

This is partly because enthusiastic practitioners are prone to using treatments that they believe will do good, without first having evaluated them adequately to ensure they do no harm to the patient. Much harm has been done to patients as a result, as in the saying,

"The treatment was a success, but the patient died." It is not only more important to do no harm than to do good; it is also important to know how likely it is that your treatment will harm a patient.

Ethical decisions should respect the values and attitudes of patients. If patients oppose vaccinations or blood transfusions for their child, their beliefs have to be taken into account, even if you, the doctor, will not ultimately follow their requests.

So a physician should go further than not prescribing medications they know to be harmful—he or she should not prescribe medications (or otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh the likely risks.

Respecting the patient's wishes has a practical consequence: Doctors who simply overrule the patient often end up seeing their treatments fail, because patients will probably be fighting them the whole way.

Patients who are overruled do not tell the truth. But patients who are in dialogue and negotiation with their doctors are more likely to come to a reasonable compromise—even if it's one the doctor doesn't entirely endorse.

Sometimes when patients or their families disagree with the doctor, the obvious ethical decision isn't the right one. Here's an example that actually occurred.

A child from southeast Asia had a clubfoot that was easily treatable, but the parents wouldn't allow treatment, evidently because they believed God had ordained clubfeet.

The caregivers rightly put the child's health first, so they went to court and obtained an order for the operation. But the outcome was appalling. The family felt that the child had lost favor with God and abandoned the child. The child in effect became an orphan. The caregivers had won the battle but lost the war.

Although physicians need to respect patients' values, physicians' own values should not sway their decisions. Conscience and the religious faith of the physician should not automatically overrule the patient's need to get the best treatment possible.

The patient's needs, however, should come before the doctors' principles. Caregivers are expected to set their beliefs aside and focus on the best interests of the patient. If you cannot bring yourself to treat a patient, you must find another doctor who will.

Values are not set in stone. They evolve as the attitudes of society change. Half a century ago, when societal norms and educational standards were changing, the medical profession shifted from paternalism (the doctor knows best) to individual autonomy (patients must be consulted).

Medical values tend to be loosely based on what a majority of the public holds to be true.

Medical values tend to be loosely based on what a majority of the public holds to be true.

ethics decisions cannot be based on public opinion because the people may not heed the values of minorities or those with views outside of the mainstream. The bottom line is that no one would want their own care decided by a bunch of inattentive and ill-informed people taking a 2-minute survey.

Also, professional codes by doctors' own organizations can help convince them that a particular ethical decision makes sense.

Doctors may also look to their hospitals' ethics committees for answers, but these committees aren't intended to be the final authorities on medical ethics. These committees are educators and work in an advisory capacity.

Their role is to develop specific hospital policies, educate staff about clinical ethics, and oversee ethical consultants on staff.

It is the individual caregiver, working in concert with the patient. Caregivers' ethical decisions go hand-in-hand with their clinical and technical decisions. Getting the ethics right depends on the integrity of the caregiver.

Because there is no preordained answer to most ethical dilemmas, even trained ethicists may disagree on solutions to the same ethical problem.

Although they tend to hold the same core values and use the same logic, they may not have gathered the same set of facts.

Ethical decisions can change over time. The values that inform a particular ethical decision may change, or the implications of a particular decision may sink in. For example, as the public has become more comfortable with physician-assisted dying, some ethicists who once opposed it have come around to supporting it.

Ethical decisions cannot be avoided. Whenever doctors make a clinical decision, they are almost always making an ethical decision, consciously or not. Rather than not thinking about the ethical dimension of your care, it makes more sense to be aware of it and make sure it is sound.

Administrative doctors clearly cannot overlook the behavior of doctors whom they oversee. It's part of their job title. But even doctors who don't have a supervisory role over colleagues have an implicit responsibility.