Principles of Clinical Ethics and Their Application to Practice

An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is...

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Published inMedical principles and practice Vol. 30; no. 1; pp. 17 - 28
Main Author Varkey, Basil
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.02.2021
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Abstract An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.
AbstractList An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.
An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.
Author Varkey, Basil
AuthorAffiliation The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
AuthorAffiliation_xml – name: The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Author_xml – sequence: 1
  givenname: Basil
  surname: Varkey
  fullname: Varkey, Basil
  email: *Basil Varkey, 120 Lakota Pass, Austin, TX 78738 (USA), basilvarkey@ymail.com
BackLink https://www.ncbi.nlm.nih.gov/pubmed/32498071$$D View this record in MEDLINE/PubMed
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Copyright 2020 The Author(s) Published by S. Karger AG, Basel
2020 The Author(s) Published by S. Karger AG, Basel.
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Issue 1
Keywords Ethics
Informed consent
Autonomy
Professionalism
Confidentiality
Integrated patient care model
Language English
License This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.
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2020 The Author(s) Published by S. Karger AG, Basel.
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References_xml – reference: Oken D. What to tell cancer patients. A study of medical attitudes. JAMA. 1961Apr;175(13):1120–8. 10.1001/jama.1961.03040130004002137305930098-7484
– reference: Mularski RA, Puntillo K, Varkey B, Erstad BL, Grap MJ, Gilbert HC, et al.. Pain management within the palliative and end-of-life care experience in the ICU. Chest. 2009May;135(5):1360–9. 10.1378/chest.08-2328194202060012-3692
– reference: Tonelli MR, Misak CJ. Compromised autonomy and the seriously ill patient. Chest. 2010Apr;137(4):926–31. 10.1378/chest.09-1574203715270012-3692
– reference: Boyle JM, Novak D. Religious and cultural perspectives in bioethics. In: Singer PA, Viens AM, editors. The Cambridge Textbook of Bioethics. New York (NY): Cambridge University Press; 2009.
– reference: Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al.. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020May;382(21):2049–55. 10.1056/NEJMsb2005114322027220028-4793
– reference: Sulmasy DP, Geller G, Levine DM, Faden RR. A randomized trial of ethics education for medical house officers. J Med Ethics. 1993Sep;19(3):157–63. 10.1136/jme.19.3.15782301480306-6800
– reference: Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. N Engl J Med. 1988Dec;319(25):1635–8. 10.1056/NEJM19881222319250432002780028-4793
– reference: Singer PA, Pellegrino ED, Siegler M. Clinical ethics revisited. BMC Med Ethics. 2001;2(1):E1. 10.1186/1472-6939-2-1113464561472-6939
– reference: Levine RJ. Informed consent: Some challenges to the universal validity of the western model. In: Vaughn L, editor. Bioethics: Principles, issues and cases. New York (NY): Oxford University Press; 2010. pp. 183–8.
– reference: Pellegrino E, Thomasma D. For the patient's good: The restoration of beneficence in health care. Oxford University Press, New York, 1988; 29. Dubler NN, Liebman CB. Bioethics Mediation: A Guide to Shaping Shared Solutions. New York, NY: United Hospital Fund of New York; 2004. Jonsen AR, Siegler M, Winslade WJ: Ethics: A practical approach to ethical decisions in clinical medicine; McGraw Hill, 2015, 8th edition.
– reference: Cardozo B: Basic right to consent to medical care- Schlendorff vs the Society of the New York Hospital, 211 NY 125 105 NE 92 1914 LEXUS 1028 (1914).
– reference: ABIM Foundation. American Board of Internal MedicineACP-ASIM Foundation. American College of Physicians-American Society of Internal MedicineEuropean Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002Feb;136(3):243–6. 10.7326/0003-4819-136-3-200202050-00012118275000003-4819
– reference: Sulmasy DP, Snyder L. Substituted interests and best judgments: an integrated model of surrogate decision making. JAMA. 2010Nov;304(17):1946–7. 10.1001/jama.2010.1595210451020098-7484
– reference: Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990Jun;112(12):949–54. 10.7326/0003-4819-112-12-94921873940003-4819
– reference: Beauchamp TL, Childress JF. Principles of biomedical ethics. New York (NY): Oxford University Press; 2009. pp. 162–4.
– reference: Guyer P. Kant on the theory and practice of autonomy. Soc Philos Policy. 2003;20(2):70–98. 10.1017/S026505250320203X0265-0525
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Snippet An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and...
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StartPage 17
SubjectTerms Beneficence
Bioethics
Clinical decision making
Confidentiality
Confidentiality - ethics
Decision making
Disclosure
Ethics, Clinical
Humans
Informed consent
Informed Consent - ethics
Morality
Morals
Negotiating
Pain
Patient-Centered Care - ethics
Patients
Personal Autonomy
Physicians
Principles
Problem Solving
Professional ethics
Professional standards
Review
Social Justice
Truth Disclosure - ethics
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Title Principles of Clinical Ethics and Their Application to Practice
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