1. Beneficence
•Do right (“good”) by the affected person.
•The physician’s main interest is the welfare of the patient.
•Do what is medically helpful.
2. Non-Maleficence
•Averting harm.
•Implement effective non-hospital treatment when feasible (due to problems that can occur during
hospitalization of elderly patients).
•Hold back diagnostic work-up or treatment when intrusion is unlikely to result in consequential
survival or patient well-being.
3. Senselessness of Therapy
•Care should be consistent with the patient’s(clinically realistic) objectives.
•Assess each and every situation individually so as to determine whether treatment would be
beneficial.
•Avoid interventions that would not benefit the patient and/or prolong suffering.
•Physician’s role as an educator helps clarify issues.
4. Confidentiality
•Total and absolute confidentiality is the underlying guiding principle.
•Comply with state regulations regarding disclosure to community health authorities and 3rd
parties.
5. Independence and Informed Consent
•A patient has the inherent right of self-determination.
•A patient has the right to consent and a right to reject diagnostic work-up or treatment. This
also means protection from unwelcome touching.
•A patient has the right to be educated on the pros and cons of a clinical conclusion.
•While patient/proxy may ask for care in excess of what is considered good medicine, discrete
autonomy should not violate the principle of beneficence and force physicians to move further
than appropriate clinical intervention.
•Autonomy ceases when a patient’s demand breaks the rules or jeopardizes public health or safety
(eg, smoking in one’s room in a LTC facility).
•A patient has the right and is encouraged to execute an advance directive. The physician’s
function as an instructor is vital in this process. State restrictions may vary.
•To formulate sovereign decisions, patients must have capacity pertaining to the complexity of
the scenario. Having said that, the degree of capacity may fluctuate as to the complexity of the
decision (refusing to be turned in bed may necessitate less mental capability than deciding on
the pros and cons of a complex surgical procedure).
•Proxy preference making may be used when a patient’s desires are unidentified or unclear or the
patient lacks faculty.
•Quantity of significance placed on the theory of independence varies with various cultures. Some
cultures might frequently employ a surrogate as the decision-maker even if the patient has
capacity to make a decision.
6. Physician-Patient Rapport
•A curative alliance should exist between physician and patient.
•There should be faithfulness, trust, confidentiality, and protection from intended harm.
•Physicians have an important responsibility in instructing their patients.
•Reveal associations that could have an effect on patient care or decisions.
7. Truth Telling
•Physicians have a responsibility to tell the truth and be honest versus partial statements of
encouragement. This should be integrated into good “bedside” demeanour and patient support.
•Technological expressions should not shroud reality and fact.
•Communicate an honest approximation of prognosis.
8. Justice
•Distribute resources and medical care in an equitable manner.
•Be fair and legal.
•Use objective resolution-making strategies, not emotional or subjective ones.
9. Non-Abandonment
•Physicians have a duty to sustain the principle of trustworthiness-not to abandon the patient
subsequent to developing a therapeutic relationship.
•A physician may voluntarily terminate charge of a patient after the patient/proxy has been
counseled and supplied with a reasonable amount of time to make other measures. The physician
might be asked to assist with these various arrangements.
•When there is conflict between a patient/proxy and physician regarding a course of medical
care, assistance may be obtained through an ethics committee, ombudsman, and/or Department of
Health.
10. Constrained Resources
•Realize that there are limited health care resources.
•Make decisions and allocate limited health care resources in a nondiscriminatory and objective
manner. |