LEC 10: BASIC PRINCIPLES OF MEDICAL ETHICS

I. 4 Principles of Medical Ethics:

These are the fundamental principles in medical ethics, guiding the actions of healthcare professionals:

1. Respect for Patient Autonomy:

• Means: Patients have the right to make their own decisions regarding their health, including the right to choose treatment methods, the right to refuse treatment, the right to be provided with full and accurate information about their condition, treatment methods, risks, and benefits.
• Note:
  • Patient autonomy is the most fundamental and important principle in medical ethics.
  • Patient autonomy may be limited in some special cases such as:
    • Patients lack the capacity to make decisions (e.g., children, mentally ill, comatose patients)
    • Patient decisions are dangerous to themselves or others.
    • Patient decisions violate the law.

2. Beneficence:

• Means: Healthcare professionals have a responsibility to act in the best interests of their patients, including providing the best possible healthcare services, helping patients recover quickly, and minimizing the harmful effects of disease.
• Note:
  • Beneficence is a principle based on concern, sharing, and kindness towards patients.
  • Healthcare professionals need to carefully consider the benefits and risks of each treatment method and choose the most appropriate option for the patient.

3. Non-maleficence:

• Means: Healthcare professionals have a responsibility to avoid harming patients, including using harmful drugs and treatments, and avoiding exploiting patients’ health.
• Note:
  • This principle requires caution, accuracy, and high professional skills from healthcare professionals.
  • Always put the patient’s interests first and minimize negative impacts.

4. Justice:

• Means: Everyone has the right to access healthcare services fairly and equally, regardless of race, gender, religion, social status, etc.
• Note:
  • This principle requires the equitable allocation of healthcare resources, ensuring the rights of all.
  • Appropriate policies are needed to address inequities in access to healthcare services.

II. Respect for Patient Autonomy:

1. Providing the best possible benefit:

• Means: Healthcare professionals have a responsibility to provide patients with the best possible healthcare services, appropriate to their condition.
• Levels of providing the best possible benefit:
  • Complete recovery.
  • Minimize disease progression.
  • Minimize the appearance of symptoms.
  • Limit the development of additional diseases, minimize sequelae, and the possibility of death.
• Note:
  • The best interests of the patient do not necessarily have to be “recovery” but must be appropriate to the needs and wishes of each individual.

2. Confidentiality:

• Means: Patient information is kept strictly confidential and is only shared when necessary to care for their health.
• Principle: “Only open information when necessary.”
• Note:
  • Confidentiality is crucial to protect patients’ privacy and dignity.
  • Disclosing patient information to others without their consent is a violation of medical ethics and can be punished by law.

3. Respecting patient’s decisions:

• Means: Patients have the right to make their own decisions regarding their health, including: choosing treatment methods, refusing treatment, participating in the treatment process.
• Note:
  • Patients have the right to change their mind at any time.
  • Healthcare professionals need to respect patients’ decisions, even if they disagree.

4. Providing full information:

• Means: Healthcare professionals are responsible for providing patients with full, accurate, and understandable information about their condition, treatment methods, risks, and benefits of each option.
• Note:
  • Information must be provided in a clear, understandable way appropriate to the patient’s level of understanding.
  • Healthcare professionals should use simple language, avoiding technical terms.
  • Provide information through various means such as: speaking, writing, images, videos.

5. Seeking patient decisions:

• Means: Healthcare professionals are responsible for communicating with patients to understand their opinions and wishes before making any decisions regarding their health.
• Content to analyze:
  • Diagnosis.
  • Examination and treatment measures to be implemented.
  • Forms of testing, intervention to be implemented.
  • Potential complications.
  • Prognosis.
  • Duration of treatment.
  • Cost of each measure.
• Note:
  • It is necessary to create favorable conditions for patients to understand the information, make decisions voluntarily and responsibly.
  • Avoid imposing personal opinions, ensuring that patients understand their rights and make appropriate decisions.

6. Cases where it is not necessary to seek patient decisions:

• There are decisions from the court, law enforcement agencies.
• Patients are not conscious enough and are unable to make decisions.
• It is significant to the community (e.g., infectious diseases).
• Patient’s family wants to find out about genetic factors.
• Note:
  • In these cases, healthcare professionals need to obtain consent from the authorized person or the patient’s legal representative.

7. Honesty, not deceiving patients:

• Means: Healthcare professionals are responsible for providing honest information to patients, not hiding information, and not making promises that cannot be fulfilled.
• Note:
  • Honesty is crucial to building trust between healthcare professionals and patients.
  • Deceiving patients can severely affect their rights and health.

III. Beneficence:

1. Consider using resources appropriate to the patient’s condition:

• Healthcare professionals should use healthcare resources effectively and economically, ensuring optimal benefits for patients.
• Note:
  • It is necessary to consider choosing treatment methods that are appropriate to the patient’s condition, ability to pay, and access to healthcare services.
  • Avoid wasting healthcare resources.

2. Consider benefits/damages:

• Healthcare professionals need to carefully consider the benefits and risks of each treatment method and choose the most appropriate option for the patient, minimizing harm and providing the best benefits.
• Note:
  • The patient’s benefits must be prioritized, but potential risks also need to be considered.

3. Treat patients like family:

• Healthcare professionals should show concern, sharing, and empathy towards patients, making them feel safe and confident.
• Note:
  • Treat patients with respect, courtesy, and care.
  • Understand the patient’s psychology and needs.

IV. Non-maleficence:

1. Consider the level of impact of benefits/risks for each medical order:

• Healthcare professionals need to carefully consider the level of impact of each medical order, ensuring that the patient’s benefits are paramount and minimizing the risk of harm.
• Note:
  • Implement medical orders accurately, carefully, and diligently.
  • Always monitor the patient’s condition after implementing the medical order.

2. Concern, actively update knowledge and skills:

• Healthcare professionals need to constantly update their knowledge and professional skills to improve their qualifications and avoid medical errors.
• Note:
  • Participate in professional training courses and seminars.
  • Follow new scientific publications.

V. Justice for Patients:

1. There is a certain priority for patients:

• When healthcare resources are scarce, there must be a certain priority for patients, ensuring that those in urgent need are prioritized in accessing healthcare services.
• Note:
  • Clear criteria are needed to classify patients according to their level of urgency.
  • Always ensure the rights of everyone, regardless of race, gender, religion, social status.

2. Horizontally:

• Everyone has the right to access healthcare services fairly and equally, regardless of race, gender, religion, social status, etc.
• Note:
  • Appropriate policies are needed to address inequities in access to healthcare services.

3. Vertically:

• Based on needs and ability to pay, patients will receive better healthcare services.
• Note:
  • An appropriate health insurance system is needed to ensure the rights of everyone.
  • Support disadvantaged groups in accessing healthcare services.

VI. General Notes:

• The 4 principles of medical ethics are fundamental principles, guiding the actions of healthcare professionals.
• In practice, there may be difficult situations that require healthcare professionals to carefully consider and make decisions that are consistent with professional ethics and the law.
• Always put the patient’s interests first, respect autonomy, confidentiality, and ensure justice for all.
• Appropriate policies are needed to ensure medical ethics and create a healthy and developing healthcare environment.
• Beyond the content presented, medical ethics includes many other complex issues that require healthcare professionals to have high knowledge, skills, and professional ethics.