Medical Ethics in AD
How Medical Ethics is Meant to Serve Patients with Autoimmune Disease
Sep 9, 2006
Medical ethics is a scientific discipline that investigates and evaluates medical issues, including treatment protocols, in terms of merits, risks, social factors, and basic human rights. Physicians, and occasionally persons without a formal medical background, who receive advanced training in medical ethics are known as bioethicists. Hospitals today have medical ethics committees consisting of physicians, nurses, technologists and bioethicists, usually physicians, who investigate and offer guidance on medical ethics issues. For patients with autoimmune diseases medical ethics is a tool, that supported by federal regulations governing patient privacy and patients' rights, allows patients the right to review their medical records and participate in their own treatment decisions.
Principles of Medical Ethics
Medical ethics includes six basic principles: Autonomy, the provision in which patients have the basic human right to refuse or choose their own treatment; Beneficence, which defines the practioner's duty to act in the best interest of the patient; Non-maleficence, which basically proscribes physicians to first do no harm; Justice, which concerns a fair distribution of health resources; Dignity, which involves the rights of both patients and practitioners to dignity; Truthfulness and honesty, which involves the patients rights to not be lied to when it comes to their diagnosis, available treatment options and their side effects, and a full disclosure of any financial ties that the practitioner has to any treatment or services that he or she is suggesting.
Autonomy Above All
Most medical ethics organizations worldwide emphasize that autonomy is the most important principle when it comes to making medical ethics decisions. In this vein, patients are encouraged and respected for their determination to seek information regarding their conditions and be allowed to make decisions based on the factors that are most important to them (for example, side effects, pain and suffering; family obligations, family history, financial issues, access to services, religious beliefs). One common example of autonomy is the right of patients who are Jehova's Witnesses to refuse blood transfusions even when to do so may put them at risk of dying. The eventual death of these patients, which is commonly witnessed by nurses and medical technologists working in transfusion medicine, is not to be judged. Nor is the patient required to defend his or her position.
Recent online discussions (see Mary Shomon's about.com thyroid site, graves_support at yahoogroups and the Graves' board at Mediboard) have focused on the rights of patients with hyperthyroidism to choose the treatment they prefer. This right is protected by HIPPA and is a basic tenet of autonomy in medical ethics. Regardless of the treatment option they choose, patients should not be slammed in medical journals, and made to feel that they're incapable of reviewing the medical literature and making their own decisions. The cavalier use of radioiodine to destroy the thyroid gland, an organ that is under attack by the immune system, should be more of a concern for bioethicists. Furthermore, condescension to patients for making their own choices is a basic violation of the principle of autonomy in medical ethics.
The Internet has proven to be an invaluable tool for patients. A recent Harvard study showed that the more experienced and confident physicians encourage their patients to learn all they can about their conditions. Physicians, it was found, who have less experience and confidence are more likely to discourage their patients and object to patients' questions regarding their diagnosis and treatment. For reasons such as this, HIPPA considers it a violation if patients are not told about all of their treatment options, including an unbiased view of the side effects of each treatment. The Internet has opened doors to patients. Responsible physicians can help by contributing to Wikepedia and bioethicists can help by defending patients' rights rather than objecting to them.
Resources:
R Gillon, Ethics needs principles-four can encompass the rest-and respect for autonomy should be "first among equals," Journal of Medical ethics, 2003; 29:307-312.
D F-C Tsai, The bioethical principles and Confucius' moral philosophy, Journal of Medical Ethics, March 1, 2005: 159-163.
Medical Ethics, from Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/Medical_ethics
