An individual medical relationship is formed by mutual agreement. In the absence of a pre-existing relationship, the physician is not ethically obligated to care for a person unless no other physician is available, as is the case in some isolated communities, or when emergency treatment is required. In these circumstances, the physician is ethically obligated to provide care and, if necessary, to arrange appropriate follow-up. Physicians may also be contractually bound to care for beneficiaries of health plans in which they participate. From the above, we see that the case manager, PE and occupational therapist are faced with an ethical emergency. They know the right steps they want to take, but they cannot take them because of institutional constraints. Since the justification of patients` rights depends on the ethical principles that preceded them, moral principles are discussed first, followed by a discussion of how they lead to patients` related rights. Generally established rights tend to derive from a fundamental set of ethical principles, including patient autonomy, charity, non-malevolence, (distributive) justice, the patient-provider fiduciary (trust) relationship, and the inviolability of human life. Determining whether one principle has greater inherent value than another is a philosophical undertaking that varies from authority to authority. In many situations, beliefs can conflict directly with each other.
If there is no legal standard, it remains the duty of the health care provider to prioritize these principles in order to achieve an acceptable outcome for the patient. Medically assisted suicide occurs when a doctor provides a medical remedy in the event of death, usually a prescription for a lethal amount of medication that the patient is taking himself. In euthanasia, the physician directly and intentionally administers a substance to cause death. Six states and the District of Columbia have legalized the practice of physician-assisted suicide in the United States (77). Many other states have held referendums and bills on both sides of the issue. Jurisdiction is a legal determination. All adult patients are considered competent to make decisions about medical care, unless a court has declared them incapable. However, in clinical practice, physicians and family members generally make decisions without a formal hearing on jurisdiction before the court for patients who do not have the capacity to make decisions (i.e., the ability to receive and express information and make choices consistent with that information and their own values). This clinical approach may be ethically justified if the physician has assessed decision-making capacity and determined that the patient is unable to understand the nature of the proposed treatment; alternatives; and the risks, benefits and consequences involved.
It can be difficult to assess a patient`s understanding. Decision-making capacity should be assessed for a given decision at a given point in time. The ability to express a particular goal or desire may exist without the ability to make more complex decisions. The greater the consequences of the decision, the more important it is to assess the capacity to make decisions. Ethics require that a physician be a person of character who can be expected to usually act in the best interests of a patient when no one is looking. Trust is essential in the healing relationship. The values or principles chosen by physicians, the theory of ethics they espouse, and how they interpret the relationship with the patient will influence the ethical choices they make. Patients may not understand or fear physicians` conflicts of interest and competing obligations that may result from cost containment and other pressures on health care funding institutions. Physicians should disclose potential conflicts of interest to their patients. While health insurance providers and institutions should hold physicians accountable for the quality, safety, and effectiveness of care, not just economic performance, they also have a duty to promote an environment of ethical practice and should not encourage physicians to participate in agreements that compromise professional and ethical standards or undermine the physician`s role as an advocate for patients.
Physicians should only enter into agreements with insurers or other stakeholders if they can ensure that the agreements do not violate professional and ethical standards. If a minor patient requests an abortion, contraceptive counselling, or treatment for sexually transmitted diseases without a parent`s knowledge or permission, the physician may want to try to convince the patient of the benefits of parental involvement, but should be aware that there may be a conflict between legal confidentiality and obligation to parents or guardians. Information should not be disclosed to third parties without the patient`s consent (25). In such cases, the physician should be guided by the best interests of the minor with respect to his or her conscience and legal responsibilities. An ethical temptation. This involves two or more courses of action, one that is morally correct and the other that is morally reprehensible, but for reasons determined by the practitioner, they deliberately choose the wrong course of action. Physicians can earn CME credits for medical-ethical training modules derived from the Code of Informed Consent and Decision Making, Physician Well-Being and Professional Conduct, Ethical Issues Related to Organ Donation, and Limits for Physicians. The physician`s professional role is to make recommendations based on the best available medical evidence and ethical standards, and to seek options that meet the patient`s unique health needs, values, and preferences (90). However, autonomy does not negate responsibility. Health care is a partnership between the health care provider and the care recipient. Each owes the other a partner and respect in health care decision-making (Veatch, 2016). An ethical certainty is that the physician or other health professional cannot make a unilateral health decision without the consent of that competent adult or emancipated minor.
Among other principles, a physician`s intention to beneficence is most often in conflict with the patient`s autonomy. This conflict has led to the development of documentation in which the patient must demonstrate an understanding of the foreseeable consequences of his decision to act against medical advice. When disagreements arise between a health care provider and a patient, the health care provider should explain the reasons for their recommendations so that the patient can make a more informed decision. As for other ethical principles, non-malevolence is most often in conflict with charity. Despite the possible reason why the treatment is beneficial, the therapy can have unintended harm. Examples include procedures that require a surgeon to cut into a patient`s body or certain medications (such as chemotherapy).