The healthcare maxim of “Do no harm” may seem simple at first glance, but it becomes increasingly complex in the face of rapidly advancing medical technology, ongoing financial constraints, and emerging health concerns. The current global effort to prevent an epidemic highlights the challenging ethical issues that arise when resources are limited, particularly in the context of new technologies such as big data and artificial intelligence (AI) that are redefining the role of healthcare practitioners.
As a result, healthcare providers are grappling with new and difficult questions around what it means to prioritize patient well-being in a constantly evolving healthcare landscape.
Every day, patients, families, and healthcare professionals are faced with a multitude of legal and ethical decisions. These can arise from a range of issues such as medical procedures, hospital management, and other aspects of the healthcare industry.
Ethical concerns in healthcare can require swift action, such as making decisions on behalf of patients who are unable to make their own, or involve lengthy and complex deliberation, such as the ongoing debates around the right to abortion or assisted suicide. At the heart of these decisions lies the need to distinguish between what is right and what is wrong, based on ethical considerations.
The choices made today can have far-reaching consequences for the future of healthcare, underscoring the importance of a thoughtful and principled approach to these complex issues.
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Principles of Determining Ethical Dilemmas
The healthcare industry is founded upon a bedrock of high ethical standards. At the core of these standards lies the field of health or medical ethics, which guides moral decision-making in the context of medical procedures and policies. In assessing the risks and benefits of medical interventions, experts such as Tom L. Beauchamp and James F. Childress have established a widely accepted framework for health ethics that centers on four fundamental principles:
# Autonomy
Autonomy in healthcare refers to a patient’s right to make decisions about their own medical care. In order to ensure that patients maintain their autonomy, healthcare providers must take steps to understand their preferences and desires when it comes to medical treatment. This includes asking patients about their treatment goals, discussing the potential benefits and risks of various interventions, and working collaboratively with patients to develop a care plan that aligns with their values and priorities. By prioritizing patient autonomy in this way, healthcare providers can help ensure that patients receive care that is respectful, effective, and aligned with their individual needs and preferences.
# Justice
Justice in healthcare refers to the fair and equitable distribution of healthcare resources and services. To promote justice, healthcare systems must establish clear limits on the availability and allocation of healthcare resources, using a fair and transparent process that takes into account the needs of all patients. This includes ensuring that healthcare resources are distributed based on need rather than other factors such as ability to pay or social status. Additionally, healthcare providers must strive to treat all patients equally, providing care that is free from discrimination and bias. By prioritizing justice in healthcare, healthcare providers can help ensure that all patients receive the care and resources they need to achieve optimal health outcomes, regardless of their individual circumstances.
# Beneficence
Beneficence in healthcare refers to the obligation of healthcare providers to act in the best interests of their patients and to promote their well-being. This includes taking steps to understand each patient’s unique needs, preferences, and circumstances, and working collaboratively with them to develop a care plan that promotes their health and well-being. Healthcare providers must also make decisions that are aimed at achieving the greatest possible benefit for their patients, while minimizing the risk of harm. To do this, they must stay up to date with the latest medical research and practice guidelines, and make evidence-based decisions that are grounded in the best available science. By prioritizing beneficence in this way, healthcare providers can help ensure that their patients receive care that is effective, safe, and aimed at achieving the best possible health outcomes.
# Non-maleficence
Non-maleficence in healthcare refers to the principle of doing no harm to patients. This means that healthcare providers have an ethical obligation to avoid causing harm to their patients, whether intentionally or unintentionally. In order to uphold this principle, healthcare providers must take steps to identify and mitigate potential risks and harms associated with medical interventions, procedures, and treatments. This includes staying informed about potential side effects and complications, using appropriate safety measures and protocols, and carefully monitoring patients for any signs of adverse reactions or complications. By prioritizing non-maleficence in this way, healthcare providers can help ensure that their patients receive care that is safe, effective, and minimizes the risk of harm.
Healthcare providers can identify ethical challenges and propose solutions by engaging in conversations with their patients about their individual needs and goals. Through these discussions, providers can gain a deeper understanding of their patients’ unique circumstances, values, and preferences, which can help them navigate complex ethical issues in healthcare. By using principles such as autonomy, beneficence, non-maleficence, and justice as a framework for decision-making, healthcare providers can work collaboratively with their patients to develop care plans that are aligned with their values and goals, while also ensuring that the provision of care is safe, effective, and equitable.
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Major Ethical Issues
The healthcare industry presents a wide range of ethical dilemmas that are faced by clinical executives, healthcare practitioners, and patients. Some of the most common medical ethics issues include:
1. The Doctor-Patient Relationship’s Confidentiality
Healthcare providers can face legal and ethical repercussions for breaching a patient’s confidentiality, as stipulated by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA mandates that physicians uphold the privacy and confidentiality of a patient’s medical records. The law also outlines who is authorized to access confidential information and who is not. Despite its apparent straightforwardness, the law contains several uncertainties and gray areas, which can make compliance challenging for healthcare providers.
If the patient or someone else is harmed, withholding information about the patient’s health, for example, could be unethical. The inverse can be equally harmful. A health practitioner could be suspended or, in some cases, fired for disclosing information about incidents on social media. HIPPA standards prohibit any sharing of health information on social media platforms, no matter how inadvertent, and state that a patient’s privacy is instantly lost following the event.
2. Negligence and Malpractice
According to a report published in the BMJ magazine, medical errors are the third biggest cause of death in the United States. Despite the fact that malpractice suits are on the decline, patients who have been injured by malpractice lawsuits may never recover. Others may have to wait an extended period of time.
The high-risk aspect of the healthcare profession can make malpractice more likely. Administrators, as well as physicians and nurses, must cover the essential tasks of patient care to avoid litigation. Faulty medical equipment, a misdiagnosis, or a delayed diagnosis are all examples of common hospital neglect. Sometimes illnesses reveal themselves in strange ways that make little sense unless the symptoms are investigated by a doctor. When professionals disagree about the therapies or tests that must be performed in order to provide proper care, lines can become blurred. Proving a cancer diagnosis might be challenging because the illness could have progressed in the same way regardless of when doctors started treatment.
3. Do-Not-Resuscitate Orders
When a patient’s heart or breathing stops, a doctor issues a Do-Not-Resuscitate (DNR) order, instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR). The DNR contains no additional treatment recommendations and can only be used after a physician has spoken with the patient.
When it’s uncertain whether or not a patient was competent of making a DNR decision, ethical issues can arise. The instance of a Florida man who was unknowingly rushed to the hospital with a “do-not-resuscitate” tattoo on his chest raised questions among hospital staff in 2017. The ICU unit opted to honor the tattoo’s message despite the man’s inability to speak after questioning the seriousness of the tattoo and his critical existing medical conditions. “The law is sometimes not agile enough to enable patient-centered treatment and regard for the patient’s best interests,” according to the ethics advice on the case.
CPR can sometimes worsen preexisting conditions, thus hospital staff should be aware of this. In such circumstances, determining if the level of discomfort is worth the benefits may help professionals make decisions that could save their lives.
4. Relationships
Engaging in sexual relationships between healthcare providers and patients or among medical staff is strictly forbidden in healthcare settings. Such behavior is considered a form of sexual harassment, which can be detrimental to all parties involved, including the healthcare facility. Therefore, the code of ethics in healthcare should explicitly prohibit such conduct.
5. Doctor-assisted Suicide
The act of purposely killing oneself with the help of someone who has the knowledge to do so is known as physician-assisted suicide. In the most fundamental sense, a physician is the only one who is totally qualified to engage in the process. Only the state has the power to make PAS illegal. According to federal legislation, legalizing PAS is a state-by-state issue. A patient who qualifies for PAS in a state that allows it must be terminally sick, capable of taking the assisted drug themselves, and intellectually capable of understanding what they’re doing.
The following are some of the problems raised by states that oppose the practice:
- The legalization of physician-assisted suicide (PAS) may create a situation where terminally ill patients feel pressured to end their lives to avoid being a burden on their loved ones.
- The practice of PAS goes against the healing role of physicians and is considered a violation of the American Medical Association’s Code of Ethics.
The issue of balancing individual autonomy and ethical considerations of healthcare practitioners is left to the states to resolve.
