Medical Ethics

1

Are there any principles of medical ethics?

Yes, there are four:

• a.

  Beneficence: The intent of doing good and offering net benefit by therapeutic intervention. This principle requires maintenance of professional knowledge and skill by ongoing education throughout one’s career.

• b.

  Nonmaleficence: The intent of not causing harm. To exercise this principle, one must know probability of harm from a proposed intervention.

• c.

  Autonomy: Deliberated self-rule requires a physician to obtain informed consent, respect privacy of healthcare information, communicate in a forthright manner that promotes trust, and respect patients’ wishes regardless of their alignment with the physician’s own beliefs.

• d.

  Justice: Acknowledgment of the patient within the context of society. This principle strives to create equitable treatments for similar patients and distribute resources as evenly as possible amongst those in need.

2

What is included in informed consent?

An informed consent discussion includes:

• a.

  Education concerning the patient’s diagnosis

• b.

  Explanation of the planned therapy in layman’s terms

• c.

  Disclosure of risks versus benefits of the proposed intervention

• d.

  Discussion of alternative therapies and their likely outcomes (including what will happen if no treatment occurs)

• e.

  Thorough answering of all patient questions and concerns

Informed consent is a voluntary decision made by the patient or a surrogate decision maker if the patient is incapacitated or a minor.

3

What is an advance directive?

An advance directive is a set of instructions delineated by a competent patient to determine their wishes for treatment at a time when he or she is no longer competent. It respects the patient’s autonomy by allowing self-determination of their future care. It assists families and physicians in decision making based on the patient’s wishes rather than a perceived sense of what is best for the patient.

Advance directives may include:

• a.

  An informal document, such as a living will, which is a list of instructions made by a competent person about future medical treatment. It produces a preillness guideline for future caregivers in accordance with the patient’s wishes.

• b.

  Formal legal appointment of a decision maker, such as a medical durable power of attorney (DPOA). A DPOA is a patient-appointed proxy decision maker. This decision maker becomes active as soon as the patient is no longer able to make competent medical decisions. The durable power of attorney must be established prior to the person becoming incapacitated.

Advance directives are activated when a patient is incapacitated by illness. Laws surrounding advance directives vary by state.

4

What is POLST?

Physician orders for life-sustaining therapy complements the advanced directive. It is designed for persons who are likely to die within the next year. The POLST includes physician orders for current therapies that align with the patient’s end-of-life care preferences. It can guide emergency personnel and inpatient care teams. It is intended for persons of any age with serious illness. Endorsement of POLST forms currently exists in 18 states, with many more states currently developing POLST programs.

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