Ethical dilemmas are commonplace in medicine and have been since the very beginnings of the profession. Over time medical ethics have evolved with time and are often shaped by significant legal cases. Despite this change, four pillars remain, ingrained into the medical profession’s core.
The four pillars each specify a different view providing medical professions with a moral compass, particularly useful with complicated decisions. However, in certain scenarios,the values and principles derived from these pillars can be contradictory and finding a resolution in these instances can be very challenging. Such hypothetical scenarios are often found in medical interviews, designed to test a candidates logic when often there is no ‘right’ answer.
Autonomy:
Each patient is in charge of their decisions and specifically has the right to decline treatment, including life saving treatments. There are a few important aspects to remember: Firstly, that patients cannot request or demand specific treatments that are not offered. Furthermore, all patients with capacity have autonomy over their decisions, but those who are deemed to lack capacity for medical reasons are often treated in their ‘best interests‘. Lastly, when considering children the line gets a bit blurry. In general we respect the child’s wishes and assess situations case per case. However, there are specific guidelines such as ‘Fraser Guidelines’ that help with decisions regarding contraception in teenagers.
Beneficence & Non-Maleficence:
Both of these principles go hand in hand together. Doctors should always maximize the benefit towards their patient in line with the words written in the hippocratic oath. Furthermore, doctors should do no harm towards the patient. There are often cases where harm may be done as an unwanted side-effect or where these principles are blurred.
Justice:
Our last pillar gives reference to the wider society and the impact that medical decisions may have in this context. Doctors should always have consideration for the law and act in line with this guidance. For the most part, a patient will remain the doctor’s priority but in certain cases, a doctor may have to break confidentiality in line with wider interests and consequently fracture the patient-doctor relationship.
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