Physicians frequently confront ethical issues in clinical practice that are perplexing, time-consuming, and emotionally draining. Experience, common sense, and simply being a good person do not guarantee that physicians can identify or resolve ethical dilemmas. Knowledge about common ethical dilemmas is also essential.
Physicians should follow two fundamental but frequently conflicting ethical guidelines: respect patient autonomy and act in the patient's best interests.
Respecting Patient Autonomy
Treating patients with respect requires doctors to accept the medical decisions of persons who are informed and acting freely. Individuals place different values on health, medical care, and risk. In most clinical settings, different goals and approaches are possible, outcomes are uncertain, and an intervention may cause both benefits and harms. Thus competent, informed patients may refuse recommended interventions and choose among reasonable alternatives.
For patients to make informed decisions, physicians need to discuss with them the nature of the proposed care, the alternatives, the risks and benefits of each, and the likely consequences, and obtain the patient's agreement to care. Informed consent involves more than obtaining signatures on consent forms. Physicians need to educate patients, answer questions, make recommendations, and help them deliberate. Patients can be overwhelmed with medical jargon, needlessly complicated explanations, or too much information at once.
Nondisclosure of Information
Physicians may consider withholding a serious diagnosis, misrepresenting it, or limiting discussions of prognosis or risks because they fear that a patient will develop severe anxiety or depression or refuse needed care. Generally, physicians should provide relevant information, while adjusting the pace of disclosure, offering empathy and hope, and helping patients cope with bad news.
In many cultures, patients traditionally are not told of a diagnosis of cancer or of other serious illness because such disclosure is believed to cause patients to suffer, while withholding information is believed to promote serenity, security, and hope. Patients should not be forced to receive information against their will, even in the name of promoting informed decisions. However, many individuals want to know their diagnosis and prognosis, even if they are terminally ill. Physicians, therefore, should ask patients how they want health care decisions to be made, adding that they usually provide information and make decisions together with patients, while offering patients the option not to receive information or to turn decision-making over to someone else.
Informed consent is not required when patients cannot give consent and when delay of treatment would place their lives or health in peril. People are presumed to want such emergency care, unless they have previously indicated otherwise.
Autonomy does not entitle patients to insist on whatever care they want. Physicians are not obligated to provide futile interventions that have no physiologic rationale or have already failed. For example, cardiopulmonary ...