Overview

Medical Ethics (or Bioethics) deals with the moral dilemmas that arise in the practice of medicine. It provides the framework for making difficult decisions about life, death, and treatment.

Core Idea

The core idea is balancing values. Medicine isn’t just about what we can do (science), but what we should do (ethics).

Formal Definition

A system of moral principles that apply values to the practice of clinical medicine. The four pillars are:

  1. Autonomy: Respecting the patient’s right to choose.
  2. Beneficence: Acting in the patient’s best interest.
  3. Non-maleficence: “First, do no harm.”
  4. Justice: Treating patients fairly and distributing resources equitably.

Intuition

It’s the moral compass of medicine.

  • Can a doctor force a Jehovah’s Witness to have a life-saving blood transfusion? (Autonomy says no).
  • Who gets the one available kidney? (Justice).
  • When should we turn off the ventilator? (Beneficence/Non-maleficence).

Examples

  • Informed Consent: Patients must understand the risks and benefits before agreeing to treatment.
  • Euthanasia/Assisted Suicide: The debate over whether doctors should help suffering patients end their lives.
  • Confidentiality: The duty to keep patient secrets (HIPAA).

Common Misconceptions

  • Misconception: Doctors swear the Hippocratic Oath.
    • Correction: Most do, but it’s symbolic. Modern ethics relies on legal and professional standards, not just an ancient Greek text.
  • Misconception: “Do no harm” means never causing pain.
    • Correction: Surgery causes pain (harm) to achieve a greater good (cure). The goal is net benefit.
  • Utilitarianism: The greatest good for the greatest number (often used in triage).
  • Deontology: Duty-based ethics (following rules regardless of consequences).
  • Paternalism: The old model where the doctor decided what was best without consulting the patient (now rejected).

Applications

  • Research: Ensuring human trials are ethical (Nuremberg Code).
  • Resource Allocation: Deciding who gets ICU beds during a pandemic.

Criticism and Limitations

  • Cultural Relativism: Ethical standards vary by culture (e.g., role of family in decision making).
  • Ambiguity: Principles often conflict (Autonomy vs. Beneficence), and there is no algorithm to resolve them.

Further Reading

  • Principles of Biomedical Ethics by Beauchamp and Childress
  • The Immortal Life of Henrietta Lacks by Rebecca Skloot