Introduction
The word ‘medical ethics’ was coined in 1803 in a book ‘Medical Ethics’ written by a physician Thomas Percival from England. This book describes the professional duties of physicians and surgeons towards their patients, fellow healthcare professionals, and the public. Since Thomas Percival was the first to use the term ‘medical ethics,’ there is a belief that the history of anything designated as medical ethics does not predate 1803. However, the field of medical ethics has had an exponential expansion over the past century. It developed as a response to the duties of healthcare professionals and the rights of patients in the face of the explosion of medical technology and its application in practice. Family medicine has evolved over the past few decades in response to the need of society for better-trained primary care physicians and to balance the highly specialized technological growth of medicine. This article discusses the ethics in family medicine in detail.
What Is Ethics in Medicine?
Ethics means the right choices of conduct considering all situations. It is the difference between what is considered right or wrong in a given culture at a given time. Ethics in medicine is concerned with the obligations of the doctors and the hospital staff to the patient and society. Healthcare systems have a set of ethics that apply to all doctors, healthcare staff, and hospitals.
What was considered good ethics some years ago may not be considered good today. Hence ethics is not static and applicable at all times. Ethics is studying or building a set of principles by which people have to live. It is a social value that enables society to decide what is right and wrong and binds society by a common opinion. It is a science of morale associated with the principle of human duty in society. Whereas the law is an obligation imposed by a competent authority and its non-compliance can lead to punishment in the form of imprisonment or fine (monetary) or both. Hence, hospital administrations should have a clear-cut understanding of their ethical and legal responsibilities.
What Is Family Medicine Ethics?
Modern medical ethical practice is largely institution-centered, fragmented, episodic, acute, and problem-focused. Whereas family medicine is based on a relationship-based model of care that is continuous, accessible, contextual, comprehensive, patient-centric, and community focused. Hence, medical ethics is more than just problem-solving for family physicians. Doing ethics in the daily practice of family medicine is different from doing ethics in various other fields of medicine, focusing on different strengths and demonstrating different values.
What Are the Common Theoretical Approaches to Address Ethical Questions in Medical Practice?
There are various theories and their different approaches to dealing with medical ethical questions in daily practices. The common theoretical approaches include:
1. Casuistry or Formal Case-Based Analysis - This approach involves examining the details of a case and evaluating those details with precedent cases with similar details. The decision on any current case is made on the practical outcomes of the prior successful cases.
2. Casuistry Modified or The Four Boxes - This approach involves examining any case by collecting details relating to the following:
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Medical Features - Noting down clinical findings, diagnoses, prognosis, and any other issues that need to be addressed.
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Patient Preferences - Noting down oral and written directives of the patient.
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Quality of Life - Evaluating how the clinical decision that is to be addressed will impact the quality and function of the patient’s life.
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Contextual Features of the Case - Evaluating any religious, legal, cultural, and financial issues.
3. Feminist Ethics or Ethics of Care - This approach involves deciding the course of action by exploring what is most loving, caring, or supporting of several possible actions that can be done or not done.
4. The Four Principles - This approach involves the following four principles -
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Autonomy - Believing that an individual has the right to control his body and his decisions.
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Non-maleficence - Doing no harm.
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Beneficence - Doing good.
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Justice - Treating everyone equally and fairly.
5. Moral Rules - This approach involves checking if there is an obvious common morality approach to the matter at hand.
6. Narrative Ethics - This approach involves determining a plan by asking and answering the question - what does the patient want the next chapter of his or her story to be? In case of several possibilities, deciding which one is the best after considering all things.
7. Virtue Ethics - The virtues include trust, prudence, justice, compassion, courage, temperance, self-effacement, and integrity. This approach involves inquiring what a virtuous person would do in a situation and what positive habits would lead to the best decision.
What Are the Steps Involved in Family Medicine Ethics?
Family medicine ethics is an important part of the family physician's daily practice. It begins with a four-step approach modified from various models of ethical decision-making. It is believed that with practice these steps will build confidence and trust and result in better outcomes, satisfaction, and improved well-being among physicians and patients.
Step 1 - Identify Situational Steps - This step involves identifying what concerns, issues, and questions appear to be at play in a given situation. At times, these situations present as conflicts, and other times these appear as simple situations that need to be clarified.
Step 2 - Identify Involved Stakeholders - This step involves identifying the web of individuals involved in the situation called stakeholders. It is important to understand how they are engaged and gather information from them. Sometimes physicians and the healthcare team themselves are stakeholders in a situation. Questions such as - who is involved? how are they related to the patient? are they willing to be a part of decision-making? need to be asked and answered.
Step 3 - Gather Objective and Subjective Data - This step involves gathering subjective and objective data, understanding them both contextually being considerate of social environment and individual experience. Objective data include what people think as hard facts and recognizing that these are influenced by perceptions and stakeholders' priorities. Subjective data include the information that each stakeholder brings to the situation. Apart from medical history, this data includes personal stories and past experiences, values, beliefs, and emotions associated with them. Factors such as age, education level, health literacy, and communication abilities influence subjective data gathering.
Step 4 - Analyze Issues and Data to Direct Action and Guide Behavior - This step involves organizing and analyzing the collected information to develop a possible plan of action for particular patients in specific situations. It involves different approaches to ethical analysis. Hence no single ethical theory applies to all circumstances.
Conclusion
In family medicine, ethics is remembering that people go to physicians for their knowledge, judgment, and skills to do the right things for clinical issues in the moment at hand and with an eye on the future. Family medicine ethics aims to determine the best plan of action that results in the best possible outcome for the patients. Its scope is broad as it examines both medical problems to be addressed and health issues to be explored and the results emerge over time. Both patients and physicians benefit from its caring and wise practice.
