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Indian Pediatr 2020;57: 288-289

Bioethics – The Secret Ingredient for a Successful Clinical Practice

 

Bakul Jayant Parekh

President, Indian Academy of Pediatrics, 2020
Email: [email protected]

 

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
• 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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