Perioperative medical ethics

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What are the four foundational moral values of medical ethics?

• Respect for autonomy: patients have the right to determine what can and cannot be done to their bodies

• Nonmaleficence: do no harm, or at least, do more good than harm

• Beneficence: do what is in the best interest of the patient

• Justice: scarce healthcare resources should be distributed as justly as possible

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Why is it important to learn about medical ethics?

Ethical questions arise frequently in medicine. Many assume that if they act in good faith and are well intentioned, they do not need to learn about medical ethics; the proper solution will simply present itself. Unfortunately, being a good person and meaning well is not enough. Like other disciplines, medical ethics involves learning to think through ethical dilemmas using reason, knowledge, and problem-solving techniques. Understanding medical ethics provides one with the tools necessary to recognize, analyze, and manage ethical dilemmas as they arise.

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What is informed consent?

Informed consent is rooted in the ethical principal of respect for patients’ autonomy. It is the cornerstone of the patient-physician relationship and no discussion of medical ethics can go far without its consideration. The goal of informed consent is to maximize the ability of patients to make reasonably informed decisions about their care, based on their understanding of the risks and benefits of the proposed intervention.

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What are the elements of informed consent?

Informed consent generally consists of the following components:

• Medical decision-making capacity

• Disclosure: the patient must be given adequate information regarding the nature and purpose of their proposed treatment, as well as risks, benefits, options, and alternatives

• Voluntariness: their decision must be voluntary and free of coercion or manipulation

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How does one determine if a patient has decisional capacity (also known as medical decision-making capacity)?

To possess medical decision-making capacity, a patient must:

• Understand the relevant information about the proposed treatment

• Appreciate their situation/medical consequences of their situation

• Use reason to make their decision; applying their life values to their knowledge of the risks and benefits of the proposed treatment or procedure—irrespective if we agree with their conclusion

• Communicate their choice to their care team

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What is the difference between capacity and competence?

Competence generally refers to legal decisions, capacity to clinical decisions. In the past, these terms were regarded as separate concepts and their use differed based on locality. However, at present, no distinction between them is usually made.

When referring to the notion of competence, societies generally determine the level of impairment necessary to render an individual patient incompetent. Societal judgement on this matter reflects the delicate balance between respecting an individual’s autonomy and protecting them from harm and/or making bad decisions.

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