Bioethics and Its Applications in Health Care

Introduction:

The process of healthcare delivery requires managed care and profound transformation. Bioethics is important to improve systems' quality, establishing a higher level of organization in healthcare delivery. Since healthcare is an essential system, assessing and processing managed care becomes ethically important rather than just operational. Ethical principles and policies are required for healthcare organizations to addressclinician and patientrelationships and healthcare delivery.

What Is Ethics?

Ethics is the guidelines for human conduct, stating and evaluating principles that govern an individual’s conduct. Ethics determines whether actions are right or wrong.

What Are Ethical Principles?

• Honesty.

• Objectivity.

• Integrity.

• Carefulness.

• Openness.

• Transparency.

• Accountability.

• Intellectual property.

• Confidentiality.

• Responsible publication.

• Responsible mentoring.

• Respect for colleagues.

• Social responsibility.

• Non-discrimination.

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• Competence.

• Legality.

• Animal care.

• Human subjects protection.

What Do You Mean By Bioethics?

Bioethics is a discipline that covers social, legal, cultural, epidemiological, and ethical issues arising due to progression in life science research and healthcare. ‘Bioethics’ was termed by Fritz Jahr in 1926, while formulating as ‘global ethics’ by Van Rensselaer Potter, an American biochemist in his book.

How Was Bioethics Originated?

During the second world war, the prisoners and detainees were taken for experimentation without their consent by Nazi human experimentation held at Nuremberg, Germany (1945 to 1947). This experimentation was done for research and development in medical science.

The code is designed to enforce integrity while exploring the subject and set out conditions for ethical treatment and behavior when involving human subjects. This code was named the Nuremberg code, a set of ethical research principles. The codes are:

1. Informed consent of the subject is essential. Consent content must align with everyone who initiates, directs, or participates in the experiment.

2. The experiment should be fruitful for society and avoid unnecessary research and methods.

3. The experiment should be based on results and knowledge of associated problems that justify the results.

4. The experiment should be conducted to avoid unnecessary physical or emotional distress and injury.

5. Experiments should not be conducted if there’s any risk of death or disability.

6. Make reasonable and appropriate provisions to protect subjects from potential injury, disability, or death, even the slightest.

7. Only a scientifically qualified person should conduct experimentation.

8. During testing, if a subject reaches a physical or mental state that makes the continuation of the experiment impossible, the subject should have the freedom to terminate the experiment.

9. During an experiment, the responsible scientist should be prepared to end the experiment.

These codes were formed to prosecute the involved nazi doctors during the trial by the American judiciaries. However, they face multiple drawbacks concerning modern medical research and practice due to a lack of upgrades and plagiarism accusations.

Similar to the nazi experiment in Europe, unethical research on syphilis came to light in Tuskegee, US, to study the cause of syphilis for over 40 years. The participants were people of African American descent enrolled for the study without informed consent. These participants were later diagnosed with syphilis, affecting their recruitment into the military during the second world war.

In late 1974, a commission was created, and the national research act was signed to identify and frame the ethical principles for conducting biomedical and behavioral research in humans.

In 1976, the commission held a four-day meeting in Belmont and created a report framing basic ethical guidelines on respect for the person, beneficence, and justice, which came to be known as the "Belmont report."

In 1979, bioethical principles were published by Beauchamp and Childress in their book that explained the four fundamental principles of biomedical research - autonomy, beneficence, nonmaleficence, and justice.

World Health Organization (WHO), United Nations Educational, Scientific, and Cultural Organizations (UNESCO), Councils for International Organizations of Medical Sciences (CIOMS), etc., came up with regulations to guide research ethics for approving biomedical research involving humans.

The IBC (International Bioethics Committee) generates universal declarations and recommendations in context with bioethics. The bioethics experts have framed guidelines to manage quality control issues due to a multidisciplinary approach.

What Are The Codes And Principles Of Biomedical Ethics?

World medical association international code of medical ethics:

Physician Responsibilities -

• The physician is expected to maintain unbiased judgment and the highest professional conduct.

• The physician must respect the patient’s right to accept or refuse treatment.

• The physician should not allow monetary gain or any such inducements to cloud his judgment or influence his opinion.

• The physician is expected to be competent professionally and morally to provide the service with compassion and respect for the patient’s dignity.

• The physician is expected to be transparent with his patient in his dealing and is expected to report those who indulge in unethical or illegal activities.

• The physician must honor the rights and wishes of the patients, co-workers, and other health professionals.

• The physician should be cautious of new discoveries, techniques, and treatment methods from noncredible sources and take his role as a public health educator seriously.

• The physician should stand guaranteed only to the facts that have been personally verified.

• The physician should use health care resources for the benefit of the patient and the community at large.

• The physician should not hesitate to seek medical attention in case of any personal mental or physical ailments.

• The physician should honor the regional and national standards of behavior.

Physician Obligation To The Sick:

• The physician is obligated to regard human life foremost.

• The physician should keep the patient’s interest foremost when treating.

• Physicians should be loyal to their patients and extend all the scientific resources available for treatment.

• The physician should respect a patient’s right to privacy.

• The physician is obligated to extend emergency medical service on compassionate grounds and withdraw only under the assurance that the highest standard of service will be provided to the patient from another equally competent source.

• The physician is not allowed to initiate or continue any physical relationship with the patient or any other deceitful or abusive relationship.

Physician Obligation To Colleagues:

• Physicians should treat others as they would like to be treated themselves.

• The physician should not use evil means or methods to entice colleagues’ patients.

• Under extraordinary circumstances, the physician can relay required patient information to co-workers and wholly respect the patient’s right to privacy.

What Is The Role Of Bioethics In Healthcare?

It is based on four basic principles;

Autonomy: It dictates that healthcare professionals respect the patient’s right to decide on treatment plans. Patient’s should be active participants. An autonomous person can deliberate about personal goals and act under the direction of such deliberation (thinking over or discussing carefully).

Consent: Informed consent is both the legal and ethical conceptessential to a patient’s right to autonomy. It is the first stated and largest principle of the Nuremberg code. The consent must be:

• Voluntary.

• Legally competent.

• Informed.

• Comprehending.

Consent must include a description of the procedures to be carried out. Following are a few of the main things a description should include:

• A description of any risks in the future or discomfort to the subject.

• A description of any benefits or others which may reasonably be expected from the treatment.

• A disclosure of any advantageous procedures or treatment course.

• A statement describing the extent, if any, will maintain the confidentiality of records identifying the subject.

• A statement that the patient has understood the procedure and is willing to undergo treatment.

• The signature of the patient and a witness.

Justice is often described as fairness or equal treatment, giving each other their rightful due. The primary duty of a healthcare professional is service, irrespective of class, creed, etc. Justice requires that each person be treated equally. The principle of justice is to protect the weak and ensure equity.

Beneficence: This principle aims at benefiting all. It should be the role of healthcare providers to benefit patients and not harm them. A patient expects beneficial action from the care provider, and there is an agreement between doctor and patient that some good will result.

Non-Maleficence: It is the foundation of morality. Although some professionals support this principle in theory, they are sometimes guilty of transgressions beyond limitation. Iatrogenic disease is the term used to describe illness due to a doctor's negligence or medical procedure or treatment. For example, the failure of instrument sterilization.

Conclusion:

Ethical codes are important for developing high standards of conduct for governing medical practices, biomedical research, and development. The professionals are expected to have respect for human beings, competence in their chosen field, integrity, and primary concern with service and not profit. Due to the rapid development of the healthcare industry in recent years, bioethics must evolve to cover and manage practical research efficiently.