Medical brain notes 42

  CREATING AN ETHICAL FRAMEWORK FOR PRACTICE AND PROFESSIONAL LIFE   Physicians often encounter ethical dilemmas in the con-text f their dealings with patients.  The use of an organizedethical framework in such situations is valuable in ensuring that evaluating situations and making decisions can be done in a sys-tematic manner, rather than based on the physician’s emotions, personal bias, or social pressures.  Physicians, in training orpractice, are expected as professionals to be able to exem-plify ethical virtues in their practice and professional life. For medicine, the organization of ethical principles into codes of conduct and useful frameworks began 2500 years ago with the Hippocratic Oath. Currently, principles have evolved into a code of professional ethics developed to guide physicians in physician–patient relationships, con-duct, and practice. Several methods for ethical decision making in med-icine exist. Each of these methods has both merits and limitat...

  ETHICAL FOUNDATIONS   Obstetrician-gynecologists, as members of the medical pro-fession, have ethical responsibilities not only to patients, but also to society, to other health professionals, and to them-selves. The ethical foundations discussed in this section are based on the five ethical principles of autonomy, benefi-cence, nonmaleficence, veracity, and justice. Patient–Physician Relationship   The welfare of the patient should be central to all considerations in the patient–physician relationship.  The right of individualpatients to make their own decisions about their healthcare is fundamental (autonomy). Physicians and other health-care providers are charged with strict avoidance of discrim-ination on the basis of race, color, religion, national origin, or any other factor. Physician Conduct and Practice   Obstetrician-gynecologists must deal honestly with pa-tients and colleagues at all times (veracity). This includes avoiding misrepresentation of the...

  ETHICAL CONSIDERATIONS IN OBSTETRICS AND GYNECOLOGY   Issues surrounding maternal and fetal rights are uniquely central to obstetrics and gynecology. The primary con-cern of physicians is to provide the best care to their pa-tients. However, recent legal actions and policies aimed at protecting the fetus as an entity separate from the woman have challenged the rights of pregnant women to make decisions about medical interventions and have criminal-ized maternal behavior that is believed to be associated with fetal harm or adverse perinatal outcomes.  Threats andincarceration have been proved to be ineffective in reducing the incidence of alcohol or drug abuse, and removing children from the home may only subject them to worse risks in the foster-care system.  ACOG and medical ethicists have consistentlymaintained that the rights of the mother in considerations of medical care or the therapeutic alliance of physician and patient take precedence over those of the fet...

  GUIDELINES FOR ETHICAL DECISION MAKING   It is important for the individual physician to find or de-velop guidelines for decision making that can be applied consistently in facing ethical dilemmas. Guidelines con-sisting of several logical steps can aid the practitioner in analyzing and resolving an ethical problem. The approach  that follows incorporates elements of several proposed schemes and is affirmed by ACOG.   ·                Identify the decision makers.  The first step in addressingany problem is to answer the question, “Whose decision is it?” Generally, the patient is presumed to have the au-thority and capacity to choose among medically accept-able alternatives or to refuse treatment. An individual’s capacity to make a decision depends on that individual’s ability to understand information and appreciate the im-plications of that information when making a personal decision. If a...