Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice

Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice

• Ethical Dilemmas in

Medical Practice

Learning Objectives

• Define the term ethical dilemmas
• Explain the characteristic of ethical dilemmas
• Explain common ethical dilemmas
• Identify sources of ethical dilemmas
• Describe strategies used to solve ethical dilemmas
• Definition of Ethical Dilemmas and
• their Characteristics
• An ethical dilemma is a situation having two or more undesirable
• alternatives.
• It can also be defined as a confusing problem that offers a choice
• between equally unsatisfactory alternatives.
• An ethical dilemma is a situation that will often involve a conflict that
• brings questions on which to obey as they may have implications on
• each other
• Ethical dilemma addresses ethical questions of right vs. wrong.
• Characteristics of Ethical Dilemmas
• In order for a problem to be an ethical dilemma it must have three
• characteristics
• The problem cannot be solved using only empirical data (empirical data is
• information derived from observation/experiences)
• The problem must be so confusing that deciding what facts and data need
• to be used in making decision is difficult.
• The results of the problem must affect more than the immediate situation;

and there should be far reaching effects.

Common Ethical Dilemmas Common

Ethical Dilemmas

• identify common ethical dilemmas in medical practice
• Dilemmas of Beneficence
• Involves deciding what is good as opposed to what is harmful.
• Often occurs when a clinician, patients, or family members disagree
• about what course of action is in the best interest of the patient.
• Dilemmas of Non-maleficence
• Involves the avoidance of harm.
• These issues often involve a clinician’s responsibility to ‘blow the
• whistle’ if the clinician sees others compromising the patient’s safety.
• In these situations, a clinician notifies higher authorities on
• weaknesses in the care they provide by not following established
• communication channels.
• Dilemmas of Autonomy
• Involves deciding what course of action maximizes the patient’s right
• of self determination.
• Autonomy issues are related to beneficence issues, especially when
• individuals other than the patient must determine what is best for the
• patient.
• Dilemmas of Justice
• Involves issues of fairness and equality, such as dilemmas that involve
• dividing limited health care resources fairly.
• Dilemmas of Fidelity
• Involves issues that involve honouring promises.
• These may include the extent and limits of a clinician’s role and
• duties to patient that might conflict with other duties such as duties
• of the laboratory technician.
• Dilemmas of Veracity
• This is an obligation to be truthful to patients and to cultivate their
• understanding of relevant consideration.
• This may involve even delivering bad news to patients and relatives.
• Sources of Ethical Dilemmas
• Problems arise when one or more ethical principles conflict with
• each other.
• Patients and clinicians- For example human rights are involved when
• a patient refuses to commit herself in signing consent while the
• clinician believes it is ethically appropriate to get his/ her permission.
• The value system, beliefs and culture- For example a patient who
• belongs to Jehovah’s Witnesses refuses blood transfusion at the time
• when blood will save the life of that individual.
• Sources of Ethical Dilemmas cntd
• Dilemma may arise from justice and conflicts between clinician and
• other health care professionals, health care organizations,
• administrators or patients and family members.
• Example one: Quick service provided to patients who can pay extra money
• and leaving patients with low economical status to wait.
• Example two: Family members may demand the HIV results of a patient and
• create a difficult situation.
• Example three: A woman may demand abortion for her school age girl who
• has been raped by a school teacher.
• Sources of Ethical Dilemmas cntd
• Technology advancement- Knowledge among people is growing and
• patients may come to the hospital with full information of their
• expectations including services like DNA, such as when the clinician is
• asked to conduct tests to confirm if the claimed father is a true father
• of the child or not.
• Technological advancement provides challenges when we are
• required to extend life support services for terminally sick patients
• and simplifies accessibility to information.
• Strategies Used to Solve Ethical
• Dilemmas
• There are no clear ways of solving the dilemmas.
• Different strategies and ways need to be applied in solving the
• dilemma as described below
• First the medical practitioner defines his/her obligations, to patients and
• fellow employees which helped her to analyze ethical conflicts.
• He/She notes that six steps proved useful to define those obligations:-
• To maximize a patient’s well being.To maximize a patient’s wellbeing.
• To balance the patient’s need for autonomy and, in the case of a minor, his/her parents’
• responsibilities for his or her wellbeing.
• To support each family member and enhance the family support system.
• To carry out the hospital’s policies.
• To protect the other patients’ good.
• To protect his or her own standards of care.
• After examining one’s obligations, it is usually recommended that four
• additional steps should be taken:
• Collect as much information as possible about the patient and other significant persons
• in the situation.
• Describe probable consequences of each of the courses of action being considered, for
• the patient and the significant others in the situations.
• Consider who should make the final decision in the matter.
• Consult other health practitioners, especially those who are prepared by practice,
• ethical committee and education to contribute meaningfully to solving problems of an
• ethical nature.
• Even after taking the steps described above, solutions may not necessarily be
• forthcoming when ethical conflicts are present.
• Commitment to ethical standards of practice is an essential part of medical
• care, as is the commitment to respecting the rights and dignity of the person

receiving care.

Key Points

• An ethical dilemma is a situation having two or more undesirable
• alternatives.
• An ethical dilemma must have three characteristics:
• The problem cannot be solve using only empirical data
• The problem must be so confusing to decide what facts are needed for
• making decision
• Results of problem must be affect more than the immediate situation
• Commitment to ethical standard of practice is an essential part of
• medical care as is the commitment to respect the rights and dignity of
• the person receiving care.
• Evaluation
• What are the characteristic of a dilemma?
• What are the common ethical dilemmas in medical practice?
• What are the sources of the ethical dilemmas?
• What are the strategies for solving ethical dilemma in medical
• practice?

References

• Beauchamp, T.L. and Childress, J. (2001). Principles of Biomedical Ethics (5th ed.). New York: Oxford University

Press.

• Burkhardt, Margareth A. & Nathaniel, A.K. (2007) Ethics and Issues in Contemporary Nursing. (3rd ed.) New

York: Thomson.

• Devettere, R.J. (1995). Practical Decision Making in Health care Ethics: Cases and Concepts. Washington DC:
• Georgetown.
• Furrow, D. (2005). Ethics: Key Concepts in Philosophy. New York, Continuum
• International Ethics Guidelines for Biomedical Research Involving Human Subject, CIOMS, Geneva, 1993.
• Mason, J.K., McCall Smith R.A. & Laurie, G.T. (1999). Law and Medical Ethics. London: Butterworths
• Mellish, J.M. & Paton, F. (1999). An Introduction to the Ethics of Nursing. Capetown: Heinemenn.
• Tanzania National Health Research Forum (2001). Guidelines on Ethics for Health Research in Tanzania.
• World Medical Association (2009). Medical Ethics Manual (2nd ed.). France: World Medical Association.