Ethical Theories and Principles in Medical Practice

Ethical Theories and Principles in Medical Practice

Learning Objectives

• By the end of this session, students are expected to be able to:
• Define common terms related to ethical
• theories and principles in medical practice
• Identify major ethical theories in medical
• practices
• Identify the importance of systematic study

of ethics to medicine

– Identify the ethical principles in medical

• practice
• Analyze ethical principles in medical
• practice
• Apply ethical principles when managing

patients/clients

Definition of Terms

Ethics

The word ethics originated from the Greek word ‘ethos’ meaning customs or character.

Ethics is a systematic study of what a persons’ conduct and actions ought to be with regard to himself or herself, other human beings and the environment.

It is concerned with judgement about what is right or wrong conduct.

Virtue

Virtue is defined as moral excellence, goodness and rightness.

It is also defined as conformity of one’s life and conduct to moral and ethical principles, uprightness, and rectitude.

Virtue Ethics

Refers to a virtue of character as a health practitioner rather than rules governing conduct or consequences of any action by a health practitioner.

Virtue ethics demands the practitioner to exercise loyalty, devotion and trustworthiness, good temperament, compassion and integrity.

Bioethics

A system of standards arising from the professional agreement to determine, sanctions, and justify the interaction of biomedical professional and patient.

Ethical Principle

Is a basic concept by which behaviour can be judged. Ethical Principles help people to make decisions, because they serve as a standard with which to measure actions.

Governing rules of conduct, as code of conduct by which life and action can be directed, or as generalization that provide a basis for reasoning.

A principle is an established rule of action to be followed in implementing a set of activities.

Values

Is something of worth or excellence or that which is esteemed, prized, or highly regarded.

Values refer to one’s evaluative judgement about what one believes is good or what makes something desirable.

Ethical Theories

Consequentialism or Utilitarianism

This is a moral theory that holds that an action is judged as good or as bad in relation to the consequence, outcome or end result that is derived from it.

According to the utilitarianism school of thought, right action is that which has great utility or usefulness. Utilitarianism holds that the only factors that make actions good or bad are the outcomes, or end results, that are derived from them.

Non-Consequentialism or Deontological Ethics

Deontological theories of ethics are based upon rationalistic view that rightness or wrongness of an act depends upon nature of the act rather than its consequences.

The term is taken from the Geek word for duty.

Ethical Theories and Principles in Medical Practice

For example, a man needs money to feed his family. He knows that he will not be able to repay it but sees that nothing will be lent to him if he does not promise to repay it at a certain time.

Deontological ethics advocates against giving wrong promises disregarding the outcome of the wrong promise, hence this man should not give the wrong promise.

Importance of Systematic Study of Ethics to Medicine

Helps in understanding the origin and process of ethical and moral thinking.

Enables health care workers to recognise situations with ethical and moral implications and make coherent and logical ethical decisions based upon recognised ethical principles and theories.

Equips medical practitioners with knowledge necessary for making right decisions in issues and situations that have element of ethical or moral uncertainty and dilemma.

Types of Ethical Principles

• There are five types of ethical principles:
• The value of life principle
• The principle of goodness or rightness
• The principle of justice or fairness
• The principle of truth telling or honesty
• The principle of individual freedom

The Value of Life Principle

This principle requires the medical practitioner to value human life and honour the patients’/clients’ wishes regarding quality of life.

It demands to recognize life as basic and important, but also life should be recognized as having an end. Yet no life should be ended without strong justification such as in the situation whereby life of a pregnant woman is threatened by the presence of the fetus.

Ethical Theories and Principles in Medical Practice

In addition, when a medical practitioner becomes negligent, he threatens the life of the patient; when life of a patient is valued, a medical practitioner will not ignore any instruction on patient’s care.

This explains why individuals should never be treated as mere means of achieving your objective, but always as a unique individual who will benefit from the results.

When medical practitioner takes part in unethical activities such as abortion, euthanasia or suicide they infringe upon this principle.

Activity: Brainstorm (15 minutes)

What are some examples of ethical principles in practice when a health care worker is on duty implementing their standard responsibilities?

Possible Answers

A medical practitioner on duty is supposed to examine patients and taking vital signs according to existing condition.

A medical practitioner is supposed to implement basic functions of their job duty that relate with the ethical principle of value of life.

As professionals, medical practitioners should implement their responsibilities not necessarily due to fear of disciplinary action but more importantly because they value the life of the client.

Example

When you have to serve a patient who previously robbed you or stole from you, what will be your feelings?

Possible Answers

Feeling of hatred, anger, revenge, anxiousness, wishing the patient to die.

One should relate reactions to the value of life. This patient should be treated like any patient even if he robbed you previously.

You must wish him quick recovery; this is the desired reaction.

Hatred, anger and revenge are undesired reactions and should not be allowed to override appropriate medical action.

The Principle of Goodness or Rightness

• This principle demands that human beings attempt to do three things:
• Promote goodness over badness (evil) and
• do good (beneficence)
• Cause no harm or badness (non-
• maleficence)
• Prevent badness or harm (non-maleficence)

Goodness or Rightness

Individuals and societies, groups and cultures have different values and ideas of what ‘good’ implies.

Certain things, however, seem to be generally recognizable as good. Examples of these things are life, pleasure, happiness, truth, knowledge, beauty, love, friendship, self-expression, freedom, peace, honour and security.

Ethical Theories and Principles in Medical Practice

A medical practitioner is obliged to avoid harm or injury/hurt to the patients/clients in all aspects by demonstrating high level of competence in her/his practices.

This principle provides justification for condemning any act that unjustly injures a person or causes them to suffer an avoidable harm.

Activity: Brainstorm (10 minutes)

Scenario

You are a health practitioner in a health facility. A person who attempted suicide is brought to the hospital you are working in. Will you start blaming him for his attempt on his own life or save his life right away?

‘What are you going to do’?

LET students discuss the two different possible reactions, and then identify which reaction is according to the ethical principle of ‘goodness’ or ‘rightness’.

SUMMARISE the discussion then continue with the presentation.

The Principle of Justice and Fairness

Issues of justice are increasingly important in health care where dwindling resources force us to make choices that are (or appear to be) not just.

The little resources available have to be shared fairly.

Distribution of resources should be done without being influenced by the socio-economic position of clients, race, religion or sex.

A health practitioner who adheres to this principle has the opportunity to utilize the available resources adequately

Therefore the health practitioner minimizes unnecessary complaints from customers, conflicts within working area and creates a sense of commitment and good relationship among staff for the benefits of the patient/client and the organization.

Ethical Theories and Principles in Medical Practice

One way that health practitioners exercise their responsibilities for allocation of resources is by avoiding wasteful and inefficient practice even when the patient requests for them.

• Examples of resource allocation include:
• Staff duty allocation
• Use of time
• Distribution of resources such as consultation
• rooms, examination gloves, stethoscopes and

BP machines

Ethical Theories and Principles in Medical Practice

In dealing with these allocation issues health practitioners must not only balance principles of compassion and justice but also which approaches to justice are preferable.

• These approaches include:
• Utilitarian- Resources should be distributed
• according to the principle of maximum

benefit for all

– Egalitarian- Resources should be distributed strictly according to the need

• Restorative-Resources should be distributed so as to favour the historically disadvantaged
• Libertarian- Resources should be distributed according to market principles (individual choice conditioned by ability and willingness to pay, with limited charity care for the destitute)

Activity: Case Study (15 minutes)

Scenario

You are the in-charge of a health centre where resources are limited and you have few in store. Most of the patients are in a bed without bed sheets. On the same day you receive a seriously ill patient who is the daughter of the council chairperson. You decide to provide this patient with a new bed sheet from the store and you allocate one nurse to ensure the wellbeing of this patient.

What do you think about this practice?

• Is it fair? Explain.

What can be done to ensure justice and fairness in a situation like this?

Possible Answers

Health professionals are morally obliged to treat all patients equally disregarding of sex, marital status, economic status etc.

The Principle of Truth Telling and Honesty (Veracity)

This is very important for the relationship with clients and colleagues. Without truth-telling, society would not function properly.

• We go to hospital because we are sure that we shall get treated, and not otherwise.

Truth does not merely mean giving information in health care.

It means adequate and right information in order for the patient to make a decision.

Patients and clients have to rely on professionals to give them information necessary to make their own decisions.

Medical practitioners share their knowledge and skills with patients and clients, rather than impose on them, so that patients and clients can take responsibility for their own care and well-being.

Activity: Exercise (5 minutes)

A patient came to hospital with uterine fibroid, and the doctor promised to remove the fibroid and leave the uterus intact. However, in the process of the operation, he did total hysterectomy without informing the patient. Two years later, the patient learned at the infertility clinic that her uterus was removed and she can never get pregnant.

ALLOW students to share reactions.

SUMMARISE by saying that the lesson here is that health workers should be truthful on patient’s condition and outcomes of care.

The Principle of Individual Freedom (Autonomy)

This principle is also called the principle of autonomy and it enables a client/patient in making any choice as he/she wishes.

Sometimes freedom is restricted in the interest of the public.

In general, health care providers are required to obtain consent because they respect an individual’s right to freedom.

An individual has the freedom to make choices about issues that affect him/her.

The concept of autonomy involves respect, the ability to determine personal goals, the capacity to decide on a plan of action, and the freedom to act on the choice which has been made.

It involves consent, which is a process whereby patients are informed of possible outcomes, possible alternatives and risks of their treatment

Managing clients without consent will result in non-compliance. Autonomy also values patient’s advance directives.

In some situations, not all patients are competent to make decisions themselves.

Examples include young children, individuals affected by certain neurological and mental health conditions and those who are temporarily unconscious. These patients require substitute decision-makers, usually a next of kin or significant others.

Activity: Case Study (15 minutes)

Scenario

A 15-year-old girl comes to the Reproductive and Child Health Clinic (RCH) where you are working and she requests for an oral contraceptive. The next day her mother confronted you for giving her daughter oral contraceptive without her consent.

What is your opinion concerning the reaction of that mother?

Do you think it was ethically proper for the health worker to offer contraceptives?

Ethical Theories and Principles in Medical Practice

The definition of a child can differ in various settings; however in sensitive issues, consent from parents may not be required. In the above scenario, the nurse was ethically proper in providing the contraceptives to the adolescent.

Other Ethical Principles

A set of other ethical principles often cited in medical texts are those described by Beuchamp and Childress (1994) in their book; ‘Principles of Biomedical Ethics’.

They are so well known that they have been called ‘The Georgetown Mantra’ as the authors were from Georgetown University.

These include the following:

• The principle of respect for autonomy – meaning state of self governance

The principle of non-maleficence – meaning not doing harm to others The principle of beneficence – meaning charitable or generous (promote the wellbeing of others) The principle of justice – meaning being fair in resource allocation and fairness