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Clinical EthicsWhat Is Clinical Ethics?Clinical ethics is part of the broader discipline of bioethics. It is a structured approach to ethical decision-making in medicine and is used to help guide choices about medical care. Bioethics is the interdisciplinary study of ethical issues arising in the life sciences, health care, and health and science policy. Clinical ethics can help to identify, understand and resolve ethical issues that arise in patient care by helping to clarify why certain actions are right or wrong. Clinical ethics uses ethical reasoning and the application of bioethical principles to resolve ethics questions. The Core Principles of Bioethics
No single principle trumps the others; their relationship is dynamic and requires clinicians to carefully evaluate each situation on its own merits and patient needs. The Difference between Morals and EthicsThese terms are often used interchangeably to refer to what is considered right or wrong. But they are not exactly the same.
An Approach to Resolving Ethics QuestionsUncertainty is an inherent part of clinical medicine because there are often multiple courses of action available—each with its own set of risks, benefits and burdens. Clinical ethics is rarely just about figuring out if something is right or wrong. Rather, it involves a deliberative process to figure out a better, more right, more reasonable, or possibly least bad option. To resolve an ethics question that arises in the course of caring for a patient it is important to:
References & Resources
High ethical standards are a must for anyone in healthcare, whether it be doctors, nurses, or administrators. To help you navigate these standards, here’s a summary of current legal and ethical issues in healthcare and how to handle ethical violations. What are ethical issues in healthcare?When it comes to healthcare, ethical issues are a field of applied ethics concerned with the moral decision-making medical staff must apply when making decisions. Moral and ethical views in medicine tend to vary based on the country and culture. Tom L. Beauchamp and James F. Childress have developed a standard approach to ethical topics in healthcare that cross borders and cultures. This ethical framework embraces four key principles of ethical decision-making within the healthcare sector.
Healthcare practitioners must collaborate with patients to understand and balance their needs and desires. For example, would it be ethical to provide a blood transfusion to a Jehovah’s Witness even if it would save their life? Modern healthcare is collaborative, and talking to patients is key to avoiding ethical violations in healthcare. Medical practitioners should never make assumptions about a patient’s needs and desires. Examples of ethical issues in healthcareWhenever a patient undergoes treatment, there are always medical ethical issues to negotiate. Issues with waiting lists, access to medical resources, and decisions on the correct course of treatment all pose ethical dilemmas. Take note: ethical is not the same as lawful. Something can be unethical but perfectly legal. For example: if the emergency room is constantly backlogged, it’s not legally required for healthcare staff to speed up their work. On the other hand, it could be considered ethical to raise the matter with the hospital’s management team to find ways to help more patients, faster. Some other examples of ethical issues in healthcare are the prioritization of treatment. Who needs immediate attention, and who should wait? Within organ donation, is it ethical to give a matching liver to an older patient who suffered from alcoholism when a younger patient would also benefit from that liver? Ethical issues in healthcare are complex, and sometimes even the right decision might not feel like the most ethical approach. 5 ethical issues in healthcareThe medical world is constantly evolving, and as medical technology changes, doctors are left with a host of new ethical issues. In a recent Sermo survey asking physicians the top medical issues they faced, the top result was balancing care quality and efficiency. Responses included:
When asked what other top ethical issues physician face in medicine, responses included:
Overcoming an ethical issue in medicine isn’t black and white, as is the case with lawful/unlawful actions. Let’s examine some of the key medical ethical issues facing healthcare staff today. 1. Do-Not-Resuscitate (DNR) OrdersDNR orders have always been controversial, as shown by the 17% of survey respondents claiming end-of-life issues as one of the top ethical issues they face. This order instructs any healthcare practitioner not to perform cardiopulmonary resuscitation (CPR) if the patient’s heart stops beating or they stop breathing. These orders may only be written in consultation with a physician and a patient. Yet one ethical issue in medicine is what happens when a patient clearly displays a DNR order? In 2017, one Florida man had a DNR order tattooed across his chest. Although the seriousness of the tattoo was questioned, the man could not breathe and could not talk, so the ICU unit decided to honor the message and opted not to initiate CPR. From an ethical standpoint, DNR orders must balance the degree of pain involved in treatment when compared to the potential benefits. As a result, addressing end-of-life issues can be challenging for physicians. For more information about DNR orders, check out this resource. 2. Patient ConfidentialityOne of the biggest legal and ethical issues in healthcare is patient confidentiality which is why 15% of survey respondents noted that doctor-patient confidentiality is their top ethical issue in practicing medicine. Healthcare practitioners have an obligation to secure and protect the privacy of all patient medical records. Under the Health Insurance Portability and Accountability Act (HIPAA), violations could lead to suspension and termination. Yet, there are gray areas, which could inadvertently lead to some ethical violations in healthcare. For example, would it cause more harm than good to withhold aspects of a patient’s medical condition? Likewise, the opposite could be true. For more information on patient confidentiality, check out this deepdive into patient confidentiality in healthcare. 3. Mandatory COVID-19 Vaccinations
Public health bodies worldwide have discussed the merits and drawbacks of implementing mandatory COVID-19 vaccination policies. This is an issue that impacts the entire healthcare industry. Many countries have made vaccinations mandatory for all staff within the healthcare sector, including in Europe and Asia. This is one of the most hotly debated current ethical issues in healthcare because it’s brought serious questions into the spotlight. Where do individual medical liberty stop and the needs of wider society start? Is it ethical to force someone into treatment if they don’t wish to undergo that treatment? For further reading, here are ethical considerations for a COVID-19 vaccine mandate. 4. Healthcare AccessibilityAccording to figures from the United States Census Bureau, 294.6 million people had health insurance in 2017, which is a record high. Despite this, one in five U.S. adults decided not to seek healthcare in 2017 because they had no insurance. The soaring cost of both healthcare and associated insurance policies leads to ethical issues, which is why 15% of our survey participants highlighted this as their top ethical issue. Is it ethical to reject someone who needs treatment based on their insurance status? Is it ethical for hospitals to charge so much for treatment? This is not only an ethical issue in medicine, but it’s a discussion often taken up in politics regarding how society wants to operate its healthcare system. It’s a debate that has raged for decades in the U.S., with no end in sight. Politically, the U.S. will see this as the defining ethical issue of our time, with profitability vs. health coming into direct conflict. 5. Allocating Limited Donor Organs, Medications and Tools of Support13% of Sermo’s survey respondents felt that allocating limited donor organs is the top ethical issue in healthcare, while 17% felt the same way about medication and tools. And it’s not surprising considering that in the United States, more than 95% of North Americans are in favor of being an organ donor yet only 58% are actually registered donors. With less than 4% of the population being on the waiting list for a donor, it can be seen that most organs in the U.S. come from deceased donors and only a small percentage come from living ones. This is why research on the ethical issues of limited donor organs is very important in order to increase the number of living donors. For more information on ethical issues in organ donation, check out Ethical principles in the allocation of human organs. Additionally, medications and tools of support can be difficult ethical issues to manage. Medication, for instance, is the best way to cure disease. Plus, acutely acting medications are used as adjunctive therapy to a primary treatment method (e.g., surgery). However, some medications are in limited supply meaning not all patients receive the medication they need. The same is true of tools of support for physicians. Different regions often offer varying degrees of support and a wide range of tools. Unfortunately, many rural areas suffer the most from lack of modern tools. Support, though, speaks more widely than to just physical components of a practice. A doctor’s work is never done, and when on-call at the hospital, there are few moments of rest in-between shifts. In order to be a hero to patients, doctors need support from colleagues and loved ones for this tough work. As a result, it’s imperative that doctors find a way to balance helping patients without neglecting family, friends, or hobbies. Notably, when asked where they found support for dealing with healthcare issues 31% of survey participants mentioned colleagues while 30% looked to professional superiors for help. How to handle ethical violations in healthcareMoral and ethical issues place a burden on nurses, doctors, and administrative staff. Although the priority should be prevention, confronting ethical missteps is a part of the profession. This is necessary because 47% of physicians have had to address ethical violations in their own practice. So, how can you best handle these violations? Our recent survey regarding this question provided the following results:
Here is a step-by-step example of how to address ethical violations at your practice. Firstly, acknowledgment and investigation of potential ethical issues in healthcare is a must. Bring together different disciplines and create an environment where people are allowed to and feel comfortable speaking up, regardless of their seniority. Next, an ethical violation should be categorized as a process issue or a regulatory issue. Remember, something can still be unethical even if it happens to be lawful. For example, when a patient’s wishes are at odds with the wishes of their families and the patient cannot speak out, what is the clinic or hospital’s policy on the right way forward? Ethical violations may require an update to internal rules and work processes. This will require consultation with frontline staff members, the administrative body, and the legal team. The best way to handle ethical problems in medicine is to adopt the following:
There’s no getting around it: ethical issues will happen. Key ethical talking points are rarely straightforward, and there are no right and wrong answers. What matters is that as part of a patient-centered care system, ethics are at the forefront. ConclusionFacing tough moral decisions places heavy stress and self-doubt upon healthcare professionals. Get guidance on confronting specific situations or simply ask for support navigating ethical issues in healthcare from doctors who have gone through similar situations. Enter the virtual doctor’s lounge and explore opinions from over 1 million doctors across 150 countries. Sermo is the world leader in bringing together expertise, experience, and cases from the frontline all in one place. Join the world’s largest physician-first online community by signing up to Sermo now. Why is an ethical approach important?Ethical values provide the moral compass by which we live our lives and make decisions – 'doing the right thing' because it's the right thing to do.
What is ethical and moral Behaviour in healthcare?Health care ethics (aka “medical ethics” or “bioethics”), at its simplest, is a set of moral principles, beliefs and values that guide us in making choices about medical care. At the core of health care ethics is our sense of right and wrong and our beliefs about rights we possess and duties we owe others.
What is an ethical approach in healthcare?Principlism is a commonly used ethical approach in healthcare and biomedical sciences. It emphasises four key ethical principles of autonomy, beneficence, non-maleficence, and justice, which are shared by most ethical theories, and blends these with virtues and practical wisdom.
Why are medical ethics important for health professionals?Doctor-patient relationships are strengthened by the practice of medical ethics, which can help you create better communication and health care decisions. Help your patients make well-considered decisions about their care and treatment by reading up on medical ethics of consent. Respecting patients' privacy is crucial.
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Why is it important to have a moral and ethical approach in any health care position?
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