The aim of this paper is to investigate the different ethical issues that arise within the medical profession and the difficult decisions that medical practitioners have to make each and every single day in their line of duty. This paper will be looking at the concept of procedure versus ethics, morals versus the norm. This paper should be able to shed light on such difficult situations and even give examples of how to deal with them.
There is the case of a patient who came from abroad and was later diagnosed to be HIV positive. He also has a partner and children who do not know about it and he is also bisexual. He only confides in me as a long time friend and I have been treating him for depression and pain for the past two years. Now, should I let the authorities know or just keep it under wraps This type of dilemma or situation, is common in the medical field with always the presence of a situation where a medical practitioner has to chose to do what is medically correct or morally correct. Thus studying judgments and moral values in relation to medicine is a field of applying ethics and this is called medical ethics. There are a couple of ethical values that normally apply in the medical and practitioners work, such as autonomy, justice, beneficence, dignity, non-maleficence and honesty. In this paper, in relation to the above case of the HIV positive patient, we are going to look at the four prima facie moral commitments. The four principles is a simple and most culturally acceptable way of approaching such issues that require ethical decisions in health care. It was developed in the United States of America, and it involved four moral commitments beneficence, justice, respect for autonomy and non-maleficence. There is also the concern about the scope of application of these basic principles. It is important to note thought that these principles do not offer an order, but instead they are just a guiding principle for members of the medical profession, in aiding them in making decisions that may arise in their work concerning moral issues. These four principles state that whatever our religion, race, or political take, a medical practitioner will find no problem in committing him or herself to the basic moral principles and being concerned about their application (Adshead, G 2000, pp 302-304).
Prima facie was a term which was introduced by a certain man named W D Ross, who happened to be an English Philosopher. Prima facie means that unless the principle is in conflict with another principle, then it is binding, but in the case where is a conflict in the principles, then the medical practitioner has to chose one. Since the four moral principles do not present a method or formula for showing what is to be done or what is right, some people have been against it, since they have been expecting a method by which you just apply it directly, the same way one would enter a problem into an algorithm and obtain an answer automatically. The scope and principles can only provide the medical practitioner with is a set of moral commitments which can aid him her in coming to an ethical decision using the preferred approach to chose whenever there is a conflict in these moral principles (Gardiner, P 2003, pp 297-302).
The first moral principle is the respect for autonomy. The word autonomy, means a deliberated self rule and it is considered a special attribute to be owned by moral agents. With the presence of autonomy within the medical practitioners, then they can be able to make decisions based on deliberation. Respect for autonomy is concerned with the respect for the autonomy of the patients, in relation to the respect for all the other parties affected. This is a moral obligation, and thus involves treating individuals as as ends in themselves and never treating them as as just a means. Respecting an individuals autonomy especially in the medical field has many prima facie meanings. One of the requirements is consulting such patients and obtaining their consent before doing anything to them. Thus it involves an obligation to get an informed agreement from the patient before offering medical help or assistance. Another implication for the respect of the autonomy of individuals is the need for medical confidentiality (Tsai, D F-C 2001, pp 44-50). There is no general or legal obligation that health professionals have to keep the work that have done on patients confidential, but there is the promise to the patients themselves that their clinical visits information and details will be kept confidential. This promise to keep the information confidential is a means of respecting the patients autonomy, and it provides a leeway for the patient to be bale to trust the medical practitioner and also be able to give more information, owing to that trust, that will enable the doctor to be able to assist him her much more better. Without such promises and keeping them, it would be difficult for the patients to divulge their sensitive information which is private and important to the doctor, thus confidentiality apart from building the trust and respecting the autonomy of the patient, also goes a long way in assisting the medical practitioner in assisting the patient (American Medical Association 2006, pp 56-98).
The lack of deceit is also an important factor of respect for autonomy and it is valued by moral agents. Such moral agents feel that their autonomy is broken when they are deceived since they usually live their lives assuming that they will not be lied to. Thus the prima facie behind the respect for this autonomy requires those in the medical profession not to lie to their patients, about the diagnosis, for example, without the patient clearly showing or stating that they need to be deceived. Keeping time on appointments is also a form of respect for autonomy, as it is by extension a promise made to the patient and not keeping time is breaking of that promise that was made to the patient. In order to exercise the respect for autonomy, medical practitioners should be able to effectively communicate with their patients. Good communication not only entails the ability to listen well, but also the ability to speak well to the patient and for the patient to be able to understand you as the doctor, in a bid to know if the patient wants a certain medical intervention to be implemented or not (Sim, J 1998, pp 3-10). Good communication is also important to the patients, as some patients do not wish to be given the finer details of their prognosis, or some do not wish to be involved in the decision making of the various options that they have for treatment, but would rather leave that decision to their doctors. In the case of our patient diagnosed with HIV, in respect for the autonomy of the patient, it would be more advisable to tell the patient that he will have to inform his family, not only because it is right, but also to be able to get the support from them and also he should do so to protect his family. In the case of the authorities, I would tell the patient that it is my duty to inform the authorities of his condition, since it is more than a moral obligation, but rather now it is a legal one. Thus I would advice the patient of my situation and the consequences that I might face if I do not inform the authorities of his condition. When there is a conflict in moral decision and a legal on, it is advisable to chose the legal one, since legal decisions are more binding as compared to the moral ones (Duncan, P 1999, pp 249-258).
In the medical profession whenever a doctor aims to help a patient, there is also a chance that he she might actually do more harm to the patient. This is where the principle of beneficence and non-maleficence comes in, where there has to be a more benefit as compared to harm. This is in line with the Hippocratic moral obligation which in essence is in the support of providing net benefit with minimal harm to all patients, which in essence means, beneficence with non-maleficence. In the pursuit of the achievement of these moral obligations, workers in the medical field are normally faced with prima facie obligations. To provide this, doctors should be able to provide the medical professionalism that they promise the patient they can offer, through serious training before and even during the doctors professional life. Also the offering of each patient net benefit should be top priority. Also the respect for the patients autonomy is important, but care has to be taken since what may be of benefit to that patient in one way, may be harmful to the same patient in a different manner. In this case of the HIV positive patient, it is difficult to decide whether to inform the authorities of his condition, and ultimately his family, and thus this causes a dilemma of sorts. Telling the family will be of benefit to the health of the patient and his partner, but may be harmful to his relationship, considering the bisexual factor of the patient. This is where as the doctor, I have to measure the benefit over the harm, and make my decision based on the beneficence and non-maleficence. Making such decisions also requires us as doctors to be able to weigh the risks and the probabilities involved in our medical assessments. In line of these two moral concepts that I have discussed, that is respect for autonomy and beneficence and non-maleficence, there has been proposals to introduce another one that is connecting these two principles and it is known as empowerment which involves doing more to help the patients to be able to do more in regards to their health (Cox, D 1995, pp 261c-262).
Justice is the fourth moral principle that is prima facie. This moral principal advocates for fairness in making of decisions where there is a conflict in choices to be made by the medical practitioner. There has been a division of the justice obligations into three categories namely, respect for the rights of the patient also known as rights based justice, there is also the distribution of scarce resources fairly also known as the distributive justice and legal justice which is the respect for the laws that are acceptable morally (Macklin, R 2003, pp 275-280). The moral strategy for justice in relation to the HIV patient is to find out whether it should be me first or the law who has to make the decision. How I am to respond to the patients request not to disclose this information to his immediate family and the relevant authorities, is distinct from the governments policy on immigrants change in HIV status. Also important is what is medical professions view on disclosing this information to the family and the relevant authorities. Lastly it was important to note the societys take or view on this situation, and if it is right for me to disclose the information. There is also the argument that it is not my role as the doctor to punish this patient due to his sexual orientation, by refusing to offer him medication, or discriminate against him. The respect for my patients rights is also very important. If
I am to disapprove of my patients sexual behavior and or orientation, it would be morally unacceptable. Going back to the fact that I should be able to accept the laws acceptable morally, I will have to break the confidence of my patient by informing the relevant authorities, especially since this is a case of an infectious disease. This is due to the legal obligations that I have. But it is also important to note that if I feel that the law is not justified morally, then I am entitled morally of course to break it, but it doesnt give me the legal entitlement to do so, and thus the legal consequences that come with the breaking of the law will be mine to face. Thus the information had to be passed on to the relevant authorities, since it was morally acceptable, and a legal obligation (Benson, J, Britten N 1996, pp 729-737).
There is also the case of the policies of the organization, society or profession. For example the hospital that I work for, have it clear in their policy regarding the transmission of HIV to immigrants that the authorities have to be informed. As a member of staff in that medical facility, I a may have argued that it is paramount that in some cases the information be kept confidential, but my arguments were not heeded to. As a member of the hospital staff, I am obliged to inform the relevant authorities since it is what is morally acceptable (Meddings, F, Haith-Cooper, M 2008, pp 52-61).
The scope of application of these medical ethics is still a bone of contention within the medical profession, with concerns rising about who and what these moral obligations are owed. For example the duty of beneficence is not owed to anyone and everyone, thus the question arises of who exactly do we owe this moral obligation and to what extent should we be wiling to assist them The non-maleficence factor of not harming anyone should be applied to not harming anyone, but who is anyone The aspect of respect for the autonomy of patients involves autonomous individuals, but who is an autonomous individual
Some of the questions can be answered automatically, for example, all the patients of the health worker falls in the medical practitioners duty of beneficence. This is usually clarified thanks to the special relationship that exists between the patients and the medical professionals. It is also clarified thanks to the legal and personal commitments that are made thanks to the societies in which these medical practitioners practice. In the issue of autonomous individuals, it is clear that a severely ill mental patient, or a newly born baby, cannot qualify as an autonomous agent. This is due to the fact that autonomy as I mentioned before, requires the ability of these patients to be able to deliberate. In this case, it is normally wise to find someone to make the decisions for the patient (Geppert, C M. A, Andrews, M R, Druyan, M E 2010, pp 79-88).
Definitely, all theories, philosophies, principles and policies have always had their fair share of critics, and these moral principles are not spared either. The medical ethics do not offer a solution to the dealing with conflicts. It is equally important to note that in my research, I am yet to find a critic requiring more principals added on to the already mentioned ones. These medical ethical values offer medical practitioners with a basic guide on dealing with moral ethical issues especially in the medical field. Since the approaches are neutral in all religious, political or even cultural ways, it is applicable to all societies, no matter which background they come from. Thus in the case of the HIV patient that I had be
There is the case of a patient who came from abroad and was later diagnosed to be HIV positive. He also has a partner and children who do not know about it and he is also bisexual. He only confides in me as a long time friend and I have been treating him for depression and pain for the past two years. Now, should I let the authorities know or just keep it under wraps This type of dilemma or situation, is common in the medical field with always the presence of a situation where a medical practitioner has to chose to do what is medically correct or morally correct. Thus studying judgments and moral values in relation to medicine is a field of applying ethics and this is called medical ethics. There are a couple of ethical values that normally apply in the medical and practitioners work, such as autonomy, justice, beneficence, dignity, non-maleficence and honesty. In this paper, in relation to the above case of the HIV positive patient, we are going to look at the four prima facie moral commitments. The four principles is a simple and most culturally acceptable way of approaching such issues that require ethical decisions in health care. It was developed in the United States of America, and it involved four moral commitments beneficence, justice, respect for autonomy and non-maleficence. There is also the concern about the scope of application of these basic principles. It is important to note thought that these principles do not offer an order, but instead they are just a guiding principle for members of the medical profession, in aiding them in making decisions that may arise in their work concerning moral issues. These four principles state that whatever our religion, race, or political take, a medical practitioner will find no problem in committing him or herself to the basic moral principles and being concerned about their application (Adshead, G 2000, pp 302-304).
Prima facie was a term which was introduced by a certain man named W D Ross, who happened to be an English Philosopher. Prima facie means that unless the principle is in conflict with another principle, then it is binding, but in the case where is a conflict in the principles, then the medical practitioner has to chose one. Since the four moral principles do not present a method or formula for showing what is to be done or what is right, some people have been against it, since they have been expecting a method by which you just apply it directly, the same way one would enter a problem into an algorithm and obtain an answer automatically. The scope and principles can only provide the medical practitioner with is a set of moral commitments which can aid him her in coming to an ethical decision using the preferred approach to chose whenever there is a conflict in these moral principles (Gardiner, P 2003, pp 297-302).
The first moral principle is the respect for autonomy. The word autonomy, means a deliberated self rule and it is considered a special attribute to be owned by moral agents. With the presence of autonomy within the medical practitioners, then they can be able to make decisions based on deliberation. Respect for autonomy is concerned with the respect for the autonomy of the patients, in relation to the respect for all the other parties affected. This is a moral obligation, and thus involves treating individuals as as ends in themselves and never treating them as as just a means. Respecting an individuals autonomy especially in the medical field has many prima facie meanings. One of the requirements is consulting such patients and obtaining their consent before doing anything to them. Thus it involves an obligation to get an informed agreement from the patient before offering medical help or assistance. Another implication for the respect of the autonomy of individuals is the need for medical confidentiality (Tsai, D F-C 2001, pp 44-50). There is no general or legal obligation that health professionals have to keep the work that have done on patients confidential, but there is the promise to the patients themselves that their clinical visits information and details will be kept confidential. This promise to keep the information confidential is a means of respecting the patients autonomy, and it provides a leeway for the patient to be bale to trust the medical practitioner and also be able to give more information, owing to that trust, that will enable the doctor to be able to assist him her much more better. Without such promises and keeping them, it would be difficult for the patients to divulge their sensitive information which is private and important to the doctor, thus confidentiality apart from building the trust and respecting the autonomy of the patient, also goes a long way in assisting the medical practitioner in assisting the patient (American Medical Association 2006, pp 56-98).
The lack of deceit is also an important factor of respect for autonomy and it is valued by moral agents. Such moral agents feel that their autonomy is broken when they are deceived since they usually live their lives assuming that they will not be lied to. Thus the prima facie behind the respect for this autonomy requires those in the medical profession not to lie to their patients, about the diagnosis, for example, without the patient clearly showing or stating that they need to be deceived. Keeping time on appointments is also a form of respect for autonomy, as it is by extension a promise made to the patient and not keeping time is breaking of that promise that was made to the patient. In order to exercise the respect for autonomy, medical practitioners should be able to effectively communicate with their patients. Good communication not only entails the ability to listen well, but also the ability to speak well to the patient and for the patient to be able to understand you as the doctor, in a bid to know if the patient wants a certain medical intervention to be implemented or not (Sim, J 1998, pp 3-10). Good communication is also important to the patients, as some patients do not wish to be given the finer details of their prognosis, or some do not wish to be involved in the decision making of the various options that they have for treatment, but would rather leave that decision to their doctors. In the case of our patient diagnosed with HIV, in respect for the autonomy of the patient, it would be more advisable to tell the patient that he will have to inform his family, not only because it is right, but also to be able to get the support from them and also he should do so to protect his family. In the case of the authorities, I would tell the patient that it is my duty to inform the authorities of his condition, since it is more than a moral obligation, but rather now it is a legal one. Thus I would advice the patient of my situation and the consequences that I might face if I do not inform the authorities of his condition. When there is a conflict in moral decision and a legal on, it is advisable to chose the legal one, since legal decisions are more binding as compared to the moral ones (Duncan, P 1999, pp 249-258).
In the medical profession whenever a doctor aims to help a patient, there is also a chance that he she might actually do more harm to the patient. This is where the principle of beneficence and non-maleficence comes in, where there has to be a more benefit as compared to harm. This is in line with the Hippocratic moral obligation which in essence is in the support of providing net benefit with minimal harm to all patients, which in essence means, beneficence with non-maleficence. In the pursuit of the achievement of these moral obligations, workers in the medical field are normally faced with prima facie obligations. To provide this, doctors should be able to provide the medical professionalism that they promise the patient they can offer, through serious training before and even during the doctors professional life. Also the offering of each patient net benefit should be top priority. Also the respect for the patients autonomy is important, but care has to be taken since what may be of benefit to that patient in one way, may be harmful to the same patient in a different manner. In this case of the HIV positive patient, it is difficult to decide whether to inform the authorities of his condition, and ultimately his family, and thus this causes a dilemma of sorts. Telling the family will be of benefit to the health of the patient and his partner, but may be harmful to his relationship, considering the bisexual factor of the patient. This is where as the doctor, I have to measure the benefit over the harm, and make my decision based on the beneficence and non-maleficence. Making such decisions also requires us as doctors to be able to weigh the risks and the probabilities involved in our medical assessments. In line of these two moral concepts that I have discussed, that is respect for autonomy and beneficence and non-maleficence, there has been proposals to introduce another one that is connecting these two principles and it is known as empowerment which involves doing more to help the patients to be able to do more in regards to their health (Cox, D 1995, pp 261c-262).
Justice is the fourth moral principle that is prima facie. This moral principal advocates for fairness in making of decisions where there is a conflict in choices to be made by the medical practitioner. There has been a division of the justice obligations into three categories namely, respect for the rights of the patient also known as rights based justice, there is also the distribution of scarce resources fairly also known as the distributive justice and legal justice which is the respect for the laws that are acceptable morally (Macklin, R 2003, pp 275-280). The moral strategy for justice in relation to the HIV patient is to find out whether it should be me first or the law who has to make the decision. How I am to respond to the patients request not to disclose this information to his immediate family and the relevant authorities, is distinct from the governments policy on immigrants change in HIV status. Also important is what is medical professions view on disclosing this information to the family and the relevant authorities. Lastly it was important to note the societys take or view on this situation, and if it is right for me to disclose the information. There is also the argument that it is not my role as the doctor to punish this patient due to his sexual orientation, by refusing to offer him medication, or discriminate against him. The respect for my patients rights is also very important. If
I am to disapprove of my patients sexual behavior and or orientation, it would be morally unacceptable. Going back to the fact that I should be able to accept the laws acceptable morally, I will have to break the confidence of my patient by informing the relevant authorities, especially since this is a case of an infectious disease. This is due to the legal obligations that I have. But it is also important to note that if I feel that the law is not justified morally, then I am entitled morally of course to break it, but it doesnt give me the legal entitlement to do so, and thus the legal consequences that come with the breaking of the law will be mine to face. Thus the information had to be passed on to the relevant authorities, since it was morally acceptable, and a legal obligation (Benson, J, Britten N 1996, pp 729-737).
There is also the case of the policies of the organization, society or profession. For example the hospital that I work for, have it clear in their policy regarding the transmission of HIV to immigrants that the authorities have to be informed. As a member of staff in that medical facility, I a may have argued that it is paramount that in some cases the information be kept confidential, but my arguments were not heeded to. As a member of the hospital staff, I am obliged to inform the relevant authorities since it is what is morally acceptable (Meddings, F, Haith-Cooper, M 2008, pp 52-61).
The scope of application of these medical ethics is still a bone of contention within the medical profession, with concerns rising about who and what these moral obligations are owed. For example the duty of beneficence is not owed to anyone and everyone, thus the question arises of who exactly do we owe this moral obligation and to what extent should we be wiling to assist them The non-maleficence factor of not harming anyone should be applied to not harming anyone, but who is anyone The aspect of respect for the autonomy of patients involves autonomous individuals, but who is an autonomous individual
Some of the questions can be answered automatically, for example, all the patients of the health worker falls in the medical practitioners duty of beneficence. This is usually clarified thanks to the special relationship that exists between the patients and the medical professionals. It is also clarified thanks to the legal and personal commitments that are made thanks to the societies in which these medical practitioners practice. In the issue of autonomous individuals, it is clear that a severely ill mental patient, or a newly born baby, cannot qualify as an autonomous agent. This is due to the fact that autonomy as I mentioned before, requires the ability of these patients to be able to deliberate. In this case, it is normally wise to find someone to make the decisions for the patient (Geppert, C M. A, Andrews, M R, Druyan, M E 2010, pp 79-88).
Definitely, all theories, philosophies, principles and policies have always had their fair share of critics, and these moral principles are not spared either. The medical ethics do not offer a solution to the dealing with conflicts. It is equally important to note that in my research, I am yet to find a critic requiring more principals added on to the already mentioned ones. These medical ethical values offer medical practitioners with a basic guide on dealing with moral ethical issues especially in the medical field. Since the approaches are neutral in all religious, political or even cultural ways, it is applicable to all societies, no matter which background they come from. Thus in the case of the HIV patient that I had be
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