Hospitalists, like all physicians, must master not only the clinical, but also the interpersonal and ethical dimensions of medical practice. Four features of Hospital Medicine generate particular ethical challenges for the practicing clinician. First, hospitalized patients often face urgent medical issues in the midst of uncertainty. Second, the patient and the hospitalist are usually strangers to one another, having met for the first time when the patient is admitted to the hospitalists' service. Decisions about code status, end-of-life care, or aggressiveness of care, difficult under the best circumstances, become even more difficult because hospitalists do not have the continuity of care many outpatient physicians have with their patients. Third, despite laudable efforts by many hospitalists to communicate with primary care providers, the absence of long-standing relationships with patients increases the challenge of knowing and representing their wishes and best interests during the course of clinical care. Finally, hospitalists' shift work also poses challenges to the communication and trust required for sound clinical decision making. Patients and family members may begin a conversation about the goals and plan of care with one hospitalist only to have to continue such a conversation with another covering physician.
Nevertheless, the ethical challenges that hospitalists face may also create opportunities to help navigate some of the most difficult clinical ethical issues in medicine. For example, the greater familiarity of hospitalists regarding decision making with the acutely ill may allow them to develop greater comfort and expertise with frequently encountered ethical dilemmas. The hospital setting also provides additional human resources to navigate the moral complexities of clinical care. These include interdisciplinary teams of nurses, social workers, chaplains, ethics consultants, and medical consultants that may be much harder to assemble in an outpatient setting.
This chapter will describe the purpose and principles of clinical ethics, explore frequently encountered inpatient clinical challenges that raise important ethical issues, and finally, highlight a number of ethical and professional issues that hospitalists face.
Many fields of ethical inquiry focus on values, standards of conduct, and moral judgment. Clinical ethics provides a structured approach for identifying, analyzing, and resolving ethical issues in clinical medicine. In addition, it allows clinicians to speak in a common language about justifications for clinical decisions that have ethical implications.
- Clinical ethics provide a structured approach for identifying, analyzing, and resolving ethical issues in clinical medicine. In addition, clinical ethics allow clinicians to speak in a common language about justifications for clinical decisions that have ethical implications.
Traditionally, bioethics has been guided by four principles: respect for autonomy, beneficence, nonmaleficence, and justice. Autonomy, personal rule of the self, is the notion that individuals acting with understanding and intentionality, free from coercion or external control, can control what happens to their bodies. Beneficence is a positive duty to act for the benefit of others, while weighing the benefits and harms to ...