Ethical Virus

Ethical health care

Medical ethics is a system of moral principles that apply values and judgments to the practice of clinical medicine and in scientific research. Medical ethics allow for people, regardless of race, gender, or religion to be guaranteed quality and principled care.[1] This applies to both the living and nonliving, such as medical research on cadavers. It creates an obvious guideline to follow. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice.[2] These tenets allow doctors, care providers, and families to create a treatment plan and work towards the same common goal without any conflict.[3] It is important to note that these four values are of equal worth.[1]

The term medical ethics first dates back to 1803, when English author and physician Thomas Percival published a document describing the requirements and expectations of medical professionals within medical facilities. The Code of Ethics was then adapted in 1847, relying heavily on Percival's words.[4] Over the years in 1903, 1912, and 1947, revisions have been made to the original document.[4] The practice of Medical Ethics is widely accepted and practiced throughout the world.[1]

There are several other codes of conduct. The Hippocratic Oath discusses basic principles for medical professionals. This document dates back to the fifth century BCE.[5] Both The Declaration of Helsinki (1964) and The Nuremberg Code (1947) are two well-known and well respected documents contributing to medical ethics. Other important markings in the history of Medical Ethics include Roe v. Wade in 1973 and the development of Hemodialysis in the 1960s. As this field continues to develop and change throughout history, the focus remains on fair, balanced, and moral thinking. Medical ethics encompasses a practical application in clinical settings as well as scholarly work on its history, philosophy, and sociology.

A common framework used in the analysis of medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook Principles of biomedical ethics. It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. The four principles are:[12]

Respect for autonomy – the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
Beneficence – a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
Non-maleficence – to not be the cause of harm. Also, "Utility" - to promote more good than harm
Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality). (Iustitia.)
Other values that are sometimes discussed include:

Respect for persons – the patient (and the person treating the patient) have the right to be treated with dignity.
Truthfulness and honesty – the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials and Tuskegee syphilis experiment.
Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts.

When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and, on occasion, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.

Autonomy   
The principle of autonomy views the rights of an individual to self-determination. This is rooted in society's respect for individuals' ability to make informed decisions about
personal matters. Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient rather than medical professionals. The increasing importance of autonomy can be seen as a social reaction to a "paternalistic" tradition within healthcare.[13] Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism to the detriment of outcomes for some patients.[14] Respect for autonomy is the basis for informed consent and advance directives.
The definition of Autonomy is the ability of an individual to make a rational, un-influenced decision. Therefore, it can be said that autonomy is a general indicator of health. The progression of many terminal diseases are characterized by loss of autonomy, in various manners. For example, dementia most always results in the loss of autonomy. Dementia is a chronic and progressive disease that attacks the brain and effects the ability to make judgments, can induce memory loss, cause a decrease in rational thinking and effect orientation.[15] This makes autonomy an indicator for both personal well-being, and for the well-being of the profession. This has implications for the consideration of medical ethics: "is the aim of health care to do good, and benefit from it?"; or "is the aim of health care to do good to others, and have them, and society, benefit from this?". (Ethics – by definition – tries to find a beneficial balance between the activities of the individual and its effects on a collective.) The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. By considering autonomy as a gauge parameter for (self) health care, the medical and ethical perspective both benefit from the implied reference to health.