Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.
Medical ethics tends to be understood narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and the critique of biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. Medical ethics shares many principles with other branches of healthcare ethics, such as nursing ethics.
There are various ethical guidelines. The Declaration of Helsinki is regarded as one of the most authoritative.
By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. For instance, authors such as Thomas Percival wrote about "medical jurisprudence" and reportedly coined the phrase "medical ethics." Percival's guidelines related to physician consultations have been criticized as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. In 1847, the American Medical Association adopted its first code of ethics, with this being based in large part upon Percival's work . While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher. In the 1960s and 1970s, building upon liberal theory and procedural justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics.
Since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula.
Values in medical ethics
In the United Kingdom, General Medical Council provides clear overall modern guidance in the form of its 'Good Medical Practice' statement. Other organisations, such as the Medical Protection Society and a number of university departments, are often consulted by British doctors regarding issues relating to ethics.
How does one ensure that appropriate ethical values are being applied within hospitals? Effective hospital accreditation requires that ethical considerations are taken into account, for example with respect to physician integrity, conflicts of interest, research ethics and organ transplantation ethics.
Autonomy
Autonomy is a general indicator of health. Many diseases are characterised by loss of autonomy, in various manners. This makes autonomy an indicator for both personal well-being, and for the well-being of the profession. This has implications for the consideration of medical ethics: "is the aim of health care to do good, and benefit from it?"; or "is the aim of health care to do good to others, and have them, and society, benefit from this?". (Ethics - by definition - tries to find a beneficial balance between the activities of the individual and its effects on a collective.)
By considering Autonomy as a gauge parameter for (self) health care, the medical and ethical perspective both benefit from the implied reference to Health.
Beneficence
James Childress and Tom Beauchamp in Principle of Biomedical Ethics (1978) identify beneficence as one of the core values of health care ethics. Some scholars, such as Edmund Pellegrino, argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception and euthanasia fall beyond its purview.
Non-Maleficence
In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and must be balanced against the principle of beneficence (doing good).
Some American physicians interpret this principle to exclude the practice of euthanasia, though not all concur. Probably the most extreme example in recent history of the violation of the non-maleficence dictum was Dr. Jack Kevorkian, who was convicted of second-degree homicide in Michigan in 1998 after demonstrating active euthanasia on the TV news show, 60 Minutes.
In some countries euthanasia is accepted as standard medical practice. Legal regulations assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients from diseases known to be incurable by the methods known in that culture. In that sense, the "Primum no Nocere" is based on the realisation that the inability of the medical expert to offer help, creates a known great and ongoing suffering in the patient . "Not acting" in those cases is believed to be more damaging than actively relieving the suffering of the patient. Evidently the ability to offer help depends on the limitation of what the practitioner can do. These limitations are characteristic for each different form of healing, and the legal system of the specific culture. The aim to "not do harm" is still the same. It gives the medical practitioner a responsibility to help the patient, in the intentional and active relief of suffering, in those cases where no cure can be offered.
"Non-maleficence" is defined by its cultural context. Every culture has its own cultural collective definitions of 'good' and 'evil'. Their definitions depend on the degree to which the culture sets its cultural values apart from nature. In some cultures the terms "good" and "evil" are absent: for them these words lack meaning as their experience of nature does not set them apart from nature. Other cultures place the humans in interaction with nature, some even place humans in a position of dominance over nature. The religions are the main means of expression of these considerations.
Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of Non-maleficence differs. Violation of non-maleficence is the subject of medical malpractice litigation. Regulations thereof differ, over time, per nation.
Double effect
Some interventions undertaken by physicians can create a positive outcome while foreseeably, but unintentionally, doing harm. The combination of these two circumstances is known as the "double effect". A commonly cited, but fallacious, example of this phenomenon is the use of morphine in the dying patient. Such use of morphine can ease the pain and suffering of the patient, while simultaneously hastening the demise of the patient through suppression of the respiratory drive. If correct, this would be an example of the double effect; however, no research evidence supports the claim that appropriately administered opioid drugs depress the respiratory system.
Informed consent
Main article: Informed consentInformed consent in ethics usually refers to the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes. It does not specifically mean the process of obtaining consent, nor the specific legal requirements, which vary from place to place, for capacity to consent. Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party. If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next-of-kin make decisions for them. The value of informed consent is closely related to the values of autonomy and truth telling.
A correlate to "informed consent" is the concept of informed refusal.
Confidentiality
Main article: ConfidentialityConfidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege.
Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.
Confidentiality is mandated in America by HIPAA laws, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years. For example, many states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles. Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient's parents. Many states in the U.S. have laws governing parental notification in underage abortion
New Jersey & Philadelphia, PA Medical Malpractice, Medical Negligence ...
What is Medical Malpractice ... of a lawyer/client relationship. Copyright 2003 - 2009 Brookman Rosenberg Brown & Sandler (BRBS): Philadelphia Mesothelioma & Medical Malpractice ...
Philadelphia Mesothelioma & Medical Malpractice Lawyers | Brookman ...
We help clients in Philadelphia and across Pennsylvania with mesothelioma lung cancer, asbestosis and medical malpractice litigation and lawsuits. Call us TOLL FREE for immediate ...
Philadelphia Medical Malpractice Attorneys - Doctor Negligence Lawyers
Tens of thousands of hospital patients are the tragic victims of medical malpractice every year. The Killino Firm in Philadelphia has the experience necessary to succesfully handle ...
Philadelphia Medical Malpractice Lawyer: PA Personal Injury Law
James I. Devine, Philadelphia personal injury lawyer handling medical malpractice claims, automobile accidents, catastrophic injury, brain injury, toxic tort, premises liability ...
Philadelphia Medical Malpractice Lawyers - Howard, Brenner & Nass, P.C ...
Philadelphia medical malpractice lawyers of Howard, Brenner & Nass, P.C. have successfully represented clients and their families in a variety of hospital, doctor, nursing home and ...
Pennsylvania Medical Malpractice Attorneys - Philadelphia Medical ...
Cherry Fieger and Marciano, LLP. - Experienced and aggressive Pennsylvania Medical Malpractice Lawyers and Malpractice Attorneys. Call for a free consultation.
Philadelphia Medical Malpractice Lawyers, Medical Malpractice Lawyers ...
Lowenthal & Abrams, Philadelphia medical malpractice lawyers, can help you receive the compensation you're entitled to if you've suffered from a medical error or mistake.
Philadelphia Medical Malpractice Lawyer Articles, Philadelphia Medical ...
Philadelphia Medical Malpractice Lawyers, Lowenthal and Abrams, provide you with medical malpractice articles and information.
Philadelphia Medical Malpractice Lawyer Frequently Asked Questions ...
The Philadelphia medical malpractice lawyers at Lowenthal and Abrams discuss and answer some common questions about medical malpractice law.
Philadelphia Medical Malpractice Law Firms | Pennsylvania (PA) Medical ...
Find a Philadelphia, Pennsylvania (PA) Medical Malpractice law firm or lawyer. Contact a Medical Malpractice attorney in Philadelphia, Pennsylvania (PA) by phone, fax or email on ...