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Medical Ethics is Primarily a Field of Applied Ethics

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  Medical ethics  is primarily a field of  applied ethics, the study of  moral values and judgments as they apply to medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Medical ethics tends to be understood narrowly as an applied professional ethics, whereas  bioethics appears to have worked more expansive concerns, touching upon the  philosophy of science and issues of   biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus. Medical ethics shares many principles with other  branches of  healthcare ethics, such as nursing ethics.  Contents [hide]     1 History     2 Values in medical ethics  o   2.1 Autonomy  o   2.2 Beneficence  o   2.3 Non-Maleficence     2.3.1 Double effect  o   2.4 Conflicts between autonomy and beneficence/non-maleficence     2.4.1 Euthanasia     3 Informed consent     4 Confidentiality     5 Criticisms of orthodox medical ethics     6 Importance of communication     7 Control and resolution  o   7.1 Guidelines  o   7.2 Ethics committees     8 Cultural concerns  o   8.1 Truth-telling  o   8.2 Online Business Practices     9 Conflicts of interest  o   9.1 Referral  o   9.2 Vendor relationships  o   9.3 Treatment of family members  o   9.4 Sexual relationships     10 Futility     11 Further reading     12 See also  o   12.1 Reproductive medicine  o   12.2 Medical research  o   12.3 Famous cases in medical ethics     13 Sources and references      14 External links  [edit] History Historically, Western medical ethics may be traced to guidelines on the duty of physicians in antiquity, such as the Hippocratic Oath, and early rabbinic and Christian teachings. In the medieval and early modern period, the field is indebted to Muslim physicians such as Ishaq bin Ali Rahawi (who wrote the Conduct of a Physician , the first book dedicated to medical ethics) and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), Jewish thinkers such as Maimonides, Roman Catholic scholastic thinkers such as Thomas Aquinas, and the case-oriented analysis (casuistry) of Catholic moral theology. These intellectual traditions continue in Catholic,  Islamic and Jewish medical ethics.  By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. For instance, authors such as Thomas Percival wrote about medical jurisprudence and reportedly coined the phrase medical ethics. Percival's guidelines related to physician consultations have  been criticized as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, guild -like nature of the physician community. [1][2]  In 1847, the American Medical Association adopted its first code of ethics, with this being based in large part upon Percival's work  [2]. While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher . In the 1960s and 1970s, building upon liberal theory and  procedural  justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into  bioethics. [3]  Since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of  Institutional Review Boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula. [4]   [edit] Values in medical ethics Six of the values that commonly apply to medical ethics discussions are:    Autonomy - the patient has the right to refuse or choose their treatment. ( Voluntas aegroti  suprema lex .)    Beneficence - a practitioner should act in the best interest of the patient. ( Salus aegroti  suprema lex .)     Non-maleficence - first, do no harm (  primum non nocere ).    Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).    Dignity - the patient (and the person treating the patient) have the right to dignity.     Truthfulness and honesty - the concept of  informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials and Tuskegee Syphilis Study. Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, the principles of autonomy and beneficence clash when  patients refuse life-saving  blood transfusion, and truth-telling was not emphasized to a large extent before the HIV era. [edit] Autonomy The principle of autonomy recognizes the rights of individuals to self determination. This is rooted in society’s respect for individuals’ ability to make informed decisions about personal matters. Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient rather than medical professionals. The increasing importance of autonomy can be seen as a social reaction to a “  paternalistic ”  tradition within healthcare. [ citation needed  ]  Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism to the detriment of outcomes for some patients [5] . Respect for autonomy is the  basis for informed consent and advance directives.  Autonomy is a general indicator of health. Many diseases are characterised by loss of autonomy, in various manners. This makes autonomy an indicator for both personal well-being, and for the well-being of the profession. This has implications for the consideration of medical ethics: is the aim of health care to do good, and benefit from it? ; or is the aim of health care to do good to others, and have them, and society, benefit from this? . (Ethics - by definition - tries to find a  beneficial balance between the activities of the individual and its effects on a collective.) By considering Autonomy as a gauge parameter for (self) health care, the medical and ethical  perspective both benefit from the implied reference to Health. [edit] Beneficence The term beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients. However, uncertainty surrounds the precise definition of which practices do in fact help patients. James Childress and Tom Beauchamp in  Principle of Biomedical Ethics  (1978) identify  beneficence as one of the core values of health care ethics. Some scholars, such as Edmund Pellegrino, argue that beneficence is the only  fundamental principle of medical ethics. They  argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception and euthanasia fall beyond its purview. [edit] Non-Maleficence Main article:  primum non nocere  The concept of non-maleficence is embodied by the phrase, first, do no harm, or the Latin,  primum non nocere . Many consider that should be the main or primary consideration (hence  primum ): that it is more important not to harm your patient, than to do them good. This is partly  because enthusiastic practitioners are prone to using treatments that they believe will do good, without first having evaluated them adequately to ensure they do no (or only acceptable levels of) harm. Much harm has been done to patients as a result. It is not only more important to do no harm than to do good; it is also important to know  how likely it is that your treatment will harm a  patient. So a physician should go further than not prescribing medications they know to be harmful - he or she should not prescribe medications (or otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh the likely risks. In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence  is not absolute, and must be balanced against the principle of   beneficence  (doing good). Non-maleficence is defined by its cultural context. Every culture has its own cultural collective definitions of 'good' and 'evil'. Their definitions depend on the degree to which the culture sets its cultural values apart from nature. In some cultures the terms good and evil are absent: for them these words lack meaning as their experience of nature does not set them apart from nature. Other cultures place the humans in interaction with nature, some even place humans in a position of dominance over nature. The religions are the main means of expression of these considerations. Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of Non-maleficence differs. Violation of non-maleficence is the subject of  medical malpractice litigation. Regulations thereof differ, over time, per nation. [edit] Double effect Some interventions undertaken by physicians can create a positive outcome while foreseeably,  but unintentionally, doing harm. The combination of these two circumstances is known as the double effect . A commonly cited, but fallacious, example of this phenomenon is the use of morphine in the dying patient. Such use of morphine can ease the pain and suffering of the  patient, while simultaneously hastening the demise of the patient through suppression of the respiratory drive. If correct, this would be an example of the double effect; however, no research

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