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Indian Pediatr 2020;57: 288-289 |
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Bioethics – The Secret Ingredient for a
Successful Clinical Practice
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Bakul Jayant Parekh
President, Indian Academy of Pediatrics, 2020
Email:
[email protected]
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If scientific knowledge is the basis, ethics is the essence of
the practice of medicine. In effect, when ethics are added to
medical practice, it becomes the proverbial icing on the cake.
You can achieve much more value by incorporating ethics into
your daily clinical practice. To succeed, medical science
needs an ethical framework, which respects the values and
attitudes of patients, to make it humane.
Medical
ethics are moral guidelines and values that guide
practitioners of clinical medicine and scientific research.
Medical ethics are values that doctors can refer to when
confused or conflicted. In today’s era, when the medical
fraternity is losing the trust of the patients, the
application of medical ethics is the need of the hour.
The term ‘ethics’ is derived from ethikos, which means ‘moral
character’ in Greek. Ethics studies rational processes that
determine the best actions when faced with conflicting
choices. They are the moral principles based on the value
system of what is good and bad, and what is right and wrong.
Laws, religion, scientific studies, philosophies, and morals
influence ethics. Some ethical issues are simple, such as
differentiating between right and wrong. However, others can
be complex, such as a decision between two ‘rights’ or two
‘wrongs’; a pair of values that conflict with each other; or
deciding between the interests and choices offered by two
different value perspectives, such as those of the patient
versus those of the doctor.
Thus, medical ethics is a
system to judge which moral principles and values are applied
to the practice of medicine, helping the doctor to decide what
is morally right. In simpler words, we must always put
ourselves in place of the patient and then think about what is
expected from the doctor. This strategy will most of the time,
help us in making the proper and ethical choice. A new concept
is bioethics, which deals with typically controversial ethical
issues emerging from new situations arising due to advances in
medicine.
There are a lot of ethical challenges in
medical practice and healthcare. Medical technologies dominate
present-day clinical practice and have not moved hand-in-hand
with the changes needed in public policy to make the benefits
accessible and affordable. About bio-ethics, the most critical
part of the Hippocratic Oath is ‘do no harm.’ When we are
almost certain that the patient is not likely to survive, and
in case of survival, the patient begets a morbid/vegetative
life, should we continue the use of life support? What about
advising patients for proceeding with stem cell infusion
without relevant, authentic data supporting this modality of
management? Another very simple to understand example is
whether we are morally/ethically right in using antibiotics
for watery diarrhea, runny nose, and/or certain viral
infections, which is leading to antimicrobial resistance
globally? As this field develops and changes, we must focus
on fairness, balance, and moral thinking across various
cultures and religious backgrounds. Medical ethics in clinical
practice is practical and not theoretical. In short, it is the
wisdom behind a successful practice. Medical ethics is a vast
field,and it is not feasible to cover all of it here. I will
elucidate some of the aspects that are more relevant to
general practice.
Some doctors think that medical
ethics is not essential and a very esoteric concept, far
removed from the practical considerations of day-to-day
clinical practice, and are more suited to the legal field.
Laws have set rules which are followed by the Government,
whereas ethics do not necessarily have a legal basis. They are
based on human principles of right and wrong. We can indeed
say that medical ethics is, first and foremost, a matter of
conscience, but it also has some practical implications and
applications.
Listening skills are essential to
medical ethics. Ethical disputes are often due to not knowing
all the facts, or not providing all the facts to patients. So
you should be a good listener to get the best diagnosis from
the history. Studies have shown that as soon as the patient
starts to complain, we tend to interrupt them within a few
seconds, thereby losing vital clues from history. Hence we
should learn to be good listeners. A well-constructed ethical
decision may not work if we have not won the patient’s
confidence. Some suggested behaviors assisting ethical
practice are listed in Box I.
Box I Suggested Behaviors to Avoid
Ethical Pitfalls in Clinical Practice
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• Ethics
requires thought. Think without inhibition.
•
There is usually no single correct answer. Discuss
these issues and seek advice freely.
• Ethical
considerations must be recorded in the same way as
clinical matters.
• Welfare of the patient
takes precedence over everything else.
• Speak
and communicate.
• Be conscious of the
patient’s right to make informed decisions, both good
and bad.
• Patients may follow bad lifestyles,
and a person may even life-saving treatment.
•
Respect the Mental Health Act.
• Be
accommodative of the fact that people have a right to
differ and not have the same values as us.
•
Not having the right to prevent a patient from
inappropriate behavior is not the same as condoning
it.
• We must exercise our right to express
our views, though we may not have the right to enforce
them.
• Always attempt to justify your
position with reason. |
Ethics is often seen as an activity that is telling us
what we cannot do. However, unlike laws that bind us, ethics
gives us the freedom to make the right choice. Relieved of
nagging doubts, we can proceed more directly and more
vigorously with our care plan. There are many reasons to take
medical ethics seriously, and here are some:
• To solve
disputes between family, patients, physicians, or others.
• In today’s world of consumerism, being ethical is more
important than making money or seeing as many patients as
possible, which indirectly helps you in gaining the confidence
of your patients and ultimately leading to a successful
practice. This will also ensure a clear conscience.
•
To maintain the respect and trust of patients. Ethical
mistakes can destroy the bond between doctor and patient.
Patients often implicitly trust their doctors, but that trust
is difficult to repair once it is breached.
• To
maintain respectful relationships with other clinicians.
• To maintain efficiency. Although ethical decision-making
often requires extra time, it also can save time by
anticipating disagreements that can slow down the care
process. If we are not ethical, patients or other caregivers
who are upset with our decisions can seriously impede our
work.
• To reduce burnout. One cause of burnout is
incongruence between physicians’ values and those of their
organization. Physicians who can describe their ethical
concerns and use negotiating skills may be able to change the
organizational policies that produce burnout.
Let us
put the effort of upholding ethics in the practice of
medicine, which will help in our uniformity and unity. And
always remember to put the beneficence of your patient first
by doing no harm at all times.
Jai Hind! Jai IAP!
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