Medical Ethics 101- How to Fill in the Gaps and Avoid Failing Humanity
These words of a well-known Neurosurgeon, practicing in a recognized hospital, under whose consultation my father was admitted came as a shock to me. Recently, my dad- a 72 year old male with usual activity level, suffered from a stroke (hemorrhagic type) leading to partial paralysis of the right side with loss of ability to speak (aphasic). His condition wasn’tcritical so soon he was shifted to the ward from the emergency as he was fully conscious and well aware of his condition. We were much relieved as we knew that he was in good hands and the stroke will take its due course of time to heal, allowing him to discharge soon.
Fortunately, all went well, and as we had proposed, the doc planned to discharge him on the third day. But after the 2nd planned CT, his condition began to deteriorate to unconsciousness, leaving all of us in great shock. After discussing with the consultant, we got to know that my dad had developed hydrocephalus which can only be relieved by a SHUNT in the brain via surgery. This comment gave us a tail spin pushing us to search for a 2nd opinion from another goodconsultantin town. Amazingly the other specialist’s opinion was against the surgery.
It raises a lot of queries about the consultant’s approach and the nursing care of the hospital. Whether there is a lapse in the nursing care service or the consultant is making a hit and try approach by keeping the patient and his kin involved in the money game. This attitude setback made me think of the basic medical ethics which I read in the initial years of my med school.
Medical ethics is about doing the right thing for achieving the best route for every individual patient. Traditionally speaking there are four basic principles of medical ethics, encompassing
Autonomy refers to the right of the patient to make one’s own decision. It is the principle that enhances the patient’s right to decide what will happen to him and the ability to make choices which should be respected by everyone. Autonomy also implies an obligation to inform and develop trust.
It is in fact, the heart and soul of health care, simply meaning doing well. Apart from the medical ethics, it is the moral duty of all the health care providers to strive for their patients’ health in every situation. This concept also ensures that any form of intervention, whether diagnostic, therapeutic or for research must be in the best possible interest of the patient.
Nonmaleficence, or avoiding harm, is the most crucial pillar of medical ethics which has most of the share of patient’s concern. No harm should be brought to the patients in terms of physical and socio-psychological aspects. The unintentional harm affecting the patient due to something done in good gesture is also included (doctrine of double effect).
It is the foundation of doctor-patient relationship. This demands to be as fair as possible, basically means giving away one his dueshare. A health care individual should be able to justify his actions in every situation. These principles help the physician to opt for the best care.
Now the best physician is the one who treats the patient in the light of his experience and learning selflessly and empathetically. He should be free from the greed of fame and money.
But in Pakistan,where the literacy rate is quiet low, the patients are not fully aware of their rights and the significance of physician’s role in practicing these ethics is increased many folds. Also,there are many traps for the physicians by the pharmaceutical companies, for exchanging expensive gifts in lieu of prescribing their drugs, sometimes by hospital administration to get the patient admitted and operated for no reason at all. This allows us to divide the physicians into two types:
Those who have undergone extensive studies and are able to correctly diagnose therefore offer a treatment depending on their learning and ethical principles and those who haven’t been through those long years of training but are very good in public dealing and are running their clinics successfully. Both are very popular among the masses. This state of affairs is contributing to increase the hardships of the patients.
How to prevent stumbles in Ethics:
The physician should keep in mind that it is her/his utmost responsibility to help patients in achieving the desired health outcomes. This can be augmented by the good patient physician relationship. These can be achieved by:
Effective and better communication both verbal and nonverbal is the bed rock of interpersonal communication. It is much more than just asking and handing a perception. To ensure that the meaning of the message is transmitted, following multiple strategies should be employed:
- Make your introduction warmly and with a smile
- Sit down and establish eye contact while listening\talking
- Listen with no interruptions and pay attention to the answers of the critical questions
- Use the language which the patient understands, avoiding medical terminology.
- Provide feedback by summarizing “ If I’m not wrong, you told me that …”
- Ask for any alternative therapy the patients are using.
Nonverbal communication is also very important forphysician patient interaction. By keeping the positive body language,simply nodding and leaning forward doctors make the patient realize his importance and assist him in opening up.
To put yourself simply at the patient’s seat and view from his perspective can be very beneficial in building trust in the relationship. Acknowledge patients feeling by saying that “that must be very difficult to you”.
Informed consent remains the burning issue of medical ethics, it usually comprises a clear explanation of the procedure, risks involved and the benefits of treatment. It also comprises of theinstruction that a person is free to withdraw his consent. Health care professional need to be sure that the patient understands the terms and conditions for treatment.
- Be Broadminded
By keeping the welfare of the patient to the front, feel comfortable in saying “I don’t know”. Keep in mind that it is not mandatory that patient will surely agree with you. Always discuss the options available in the atmosphere of mutual respect.
- Ethics is about thinking.
Don’t hesitate to think.There may be more than one correct answer. Ask issues and seek advice from the experienced.
Medical ethics because of its complexity and human involvement is a very delicate process to balance. To balance the ethical principles with the provision of the best care should be the target of the today’s physician. I summarize in the words of Al-Tabari, the great Muslim physician and the author of the bible of knowledge “Firdaus- ul- Hikmat”, which formed the basics of medical sciences:
“It is essential for a physician to be kind, generous and of good character. A physician should be more kind to his patients than to his own relation and serve the patient before self. Neither should he be greedy of money. These traits will cause damage to his rank and nobility.”
- Zaidi, Shabih H.(2014), Ethics in Medicine, Springer International Publishing.
About the Author: Myda Tahir is a medical professional graduated from DMC, Karachi, Pakistan, who is now doing her Post Graduation from CPSP. She is a passionate writer with a special interest in health, education and creativity.
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