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medical ethics

A set of principles that guide physicians in their relationships with patients & others. 4 tenets of medical ethics 1) autonomy 2) beneficence 3) nonmaleficence 4) justice Management: - from ethical & legal perspectives, stopping life-sustaining therapy is no different than not starting it - interventions should not be withheld because of fear that they cannot be withdrawn [2] - mediation & resolution of disputes may be best provided by an ethics consultant or a family therapist [3,4] - identify parties to the conflict - understand to explicit as well as the unstated interests of the participants - help participants define their interests - moderate disparities of power, knowledge, skill, and experience among participants - search for common ground or areas of consensus - identify options for conflict resolution that are compatible with principles of bioethics and legal rights of patients and families - write a chart note that makes the terms of consensus accessible to all members of the healthcare team, on all shifts - track implementation of the agreement - follow-up Notes: - ethical issues in medicine are dynamic & will continue to change - the current International Code of Medical Ethics (ICME) consists of 4 sections - duties of physicians in general - practices deemed to be unethical - duties of physicians to the sick - duties of physicians to each other [7,8] - the ICME is based on the Declaration of Geneva, adopted by the World Medical Association in 1948 & reaffirmed in 1994 [7,8]

Related

advance directives ageism competence conservatorship decision making decision-making capacity; decisional capacity declaration of Helsinki disclosure do not resuscitate (DNR); do not attempt rescuscitation (DNAR) futility guardianship informed consent/refusal medical malpractice, litigation ombudsman paternalism substituted judgement surrogate decision maker (proxy)

Specific

autonomy beneficence ethical dilemma fidelity justice nonmaleficence Patient Self-Determination Act of 1991 (PSDA) respect

General

ethics medical specialty

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 581
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012 - Snyder L American College of Physicians Ethics Manual, Sixth Edition Annals of Internal Medicine 2012, 156(1):73-104 PMID: 22213573 http://www.annals.org/content/156/1_Part_2/73.full.pdf+html - Emanuel EJ Review of American College of Physicians Ethics Manual, Sixth Edition Annals of Internal Medicine 2012, 156(1):56-57 http://www.annals.org/content/156/1_Part_1/56.full.pdf+html
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Dubler NN, Webber MP, Swiderski DM Faculty and the National Working Group for the Clinical Ethics Credentialing Project. Charting the future. Credentialing, privileging, quality, and evaluation in clinical ethics consultation. Hastings Cent Rep. 2009 Nov-Dec;39(6):23-33. PMID: 20050368
  5. Gold KJ et al No Appointment Necessary? Ethical Challenges in Treating Friends and Family. N Engl J Med 2014. 371:1254-1258. September 25, 2014 PMID: 25251620 http://www.nejm.org/doi/full/10.1056/NEJMsb1402963
  6. Farley TA Perspective. When Is It Ethical to Withhold Prevention? N Engl J Med 2016; 374:1303-1306. April 7, 2016 PMID: 27050204 http://www.nejm.org/doi/full/10.1056/NEJMp1516534
  7. Parsa-Parsi RW The International Code of Medical Ethics of the World Medical Association. JAMA. Published online October 13, 2022. PMID: 16369347 Free PMC article https://jamanetwork.com/journals/jama/fullarticle/2797507
  8. Sulmasy LS, Bledsoe TA; ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians ethics manual: seventh edition. Ann Intern Med. 2019;170:S1-S32. PMID: 30641552
  9. World Medical Association International Code of Medical Ethics. http://www.wma.net/e/policy/c8.htm.