Foundations and Principles of Medical Ethics

The document provides an overview of the content of a course on communication skills and medical ethics. Ethics is concerned with what is good for individuals and society. It involves developing, systematizing, defending, and recommending concepts of right and wrong behaviour. The term ethics is derived from Greek noun meaning ‘character’ or ‘disposition’ and is used in Aristotle to denote those aspects of one's character that, through appropriate moral training, develop into virtues.

Philosophical Basis of Medical Ethics

The philosophical basis and principles of medical ethics examine key concepts like ethical theories of deontology and utilitarianism. In Utilitarianism, Mill argued that it is “the business of ethics to tell us what are our duties, or by what test we may know them. The document delves into philosophical perspectives like Kantian deontology and utilitarianism as put forth by philosophers like Jeremy Bentham and John Stuart Mill, while also noting some limitations of utilitarian thinking. Ancient, liberal, and socialist philosophies were the main engines for crafting the new field.

Historical Context

Thomas Percival introduced the term “medical ethics” in 1803. Percival wrote mainly about decorum but also examined the conduct of physicians in society. In 1847, the American Medical Association adopted its first code of ethics, largely based on Percival’s work. Western medical ethics as a field of studies emerged and began to crystallise as part of the revival of applied ethics during the second half of the 20th Century. This period of time witnessed scientific discoveries and technological innovations on the one hand, and growing patients’ objections to medical paternalism on the other. These developments brought about the need to rethink and rephrase medical obligations and patients’ rights.

The Four Main Principles of Medical Ethics

The following are the four main principles of medical ethics:

• Beneficence (doing good)
• Non-maleficence (to do no harm)
• Autonomy (giving the patient the freedom to choose freely, where they are able)
• Justice (ensuring fairness)

The Principle of Beneficence

Beneficence is a value in which the provider takes actions or recommends courses that are in the patients based interest. It is not coercing or manipulating the patient into making a decision against their values, even though it may objectively be the best decision for their health. It is not euthanasia (in most states). It is important to keep the individual patients in mind because beneficence is not the same in all situations. When patient autonomy is compromised (e.g, incapcity) Beneficence must be the guiding ethics.

The Physician-Patient Relationship

Philosophical underpinnings are designed to administer unequal power relations between patients and physicians. Patients lack knowledge, experience and expertise, and furthermore, their ailment put them in a vulnerable condition. They voluntarily trust their fate in the hands of physicians who have significant power over the patient. Medical ethics aims to protect the best interests of patients and those of the medical profession, equipping both with conceptual tools to assess the relationships and help in preventing potential abuse of power.

Professional Practice and Contemporary Challenges

The course explores medical ethics and professional practice, including:

• Medical research and ethics
• Policy, legislation and regulation
• Clinical incompetence
• Interprofessional relationships
• Relationship with unqualified practioners and traditional healers
• The ethical dimensions: Responsibility to the Community

Furthermore, it covers the perspective of some of the most complex ethical challenges of our time, such as the challenge of Siamese twins, defining parenthood through the challenges of IVF (In Vitro Fertilization), and pulling the plug to relieve suffering. Other critical issues include Privacy vs. Spousal Safety regarding the limits of patient-doctor confidentiality and organ donation.