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Ethics in Clinical Practice

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Principles and Practice of Geriatric Surgery

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Abstract

Normative ethics addresses the criteria or standards by which we judge whether an action is considered to be right or wrong. Medical ethics is built on a utilitarian ethical structure; it bases what we ought to do on competing principles that are applied in the context of the clinical setting and not on overarching deontological moral imperatives. The guiding principles of American medical ethics are those of respect for autonomy, nonmaleficence, beneficence, and justice (Table 14.1). Autonomy is defined as the right to self-determination, the right to make one’s own choices. The principle of nonmaleficence, often equated with the phrase primum non nocere, first do no harm, is better described as the obligation not to knowingly do harm by either an action or the omission of an action. Beneficence is the act of doing the most possible good; to take the action which will result in the most beneficial outcome for the patient. Justice, in the context of health care, refers to equality of medical treatment and the access to care. For any given clinical situation, the application of each of these principles may give different answers to what is right or wrong [1].

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References

  1. Beauchamp TL, Childress JF (2009) Principles of biomedical ethics, 6th edn. Oxford University Press, New York, NY, p 15

    Google Scholar 

  2. Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S (1995) Ethnicity and attitudes toward patient autonomy. JAMA 274:820–825

    Article  PubMed  CAS  Google Scholar 

  3. Fitts WT, Ravdin IS (1953) What Philadelphia physicians tell patients with cancer. JAMA 153:901–904

    Article  Google Scholar 

  4. Oken D (1961) What to tell cancer patients: a study of medical attitudes. JAMA 175:1120–1128

    Article  PubMed  CAS  Google Scholar 

  5. Novack DH, Olumer R, Smith RL, Ochitill H, Morrow GR, Bennett JM (1979) Changes in physicians’ attitudes toward telling the cancer patient. JAMA 241:897–900

    Article  PubMed  CAS  Google Scholar 

  6. Drickamer MA, Lachs LS (1992) Should patients with Alzheimer’s disease be told their diagnosis? N Engl J Med 336:947–951

    Article  Google Scholar 

  7. Drickamer MA, Lachs LS (1993) Telling the diagnosis of Alzheimer’s disease. N Engl J Med 328:442

    Google Scholar 

  8. Braddock CH, Edwards KA, Hasenber NM, Laidley TL, Levinson W (1999) Informed decision making in outpatient practice: time to get back to basics. JAMA 282:2313–2320

    Article  PubMed  Google Scholar 

  9. Epstein RM, Alper BS, Quill TE (2004) Communicating evidence for participatory decision making. JAMA 291:2359–2366

    Article  PubMed  CAS  Google Scholar 

  10. Ford S, Scofield T, Hope T (2003) What are the ingredients for a successful evidence-based patient choice consultation? A qualitative study. Soc Sci Med 56:589–602

    Article  PubMed  Google Scholar 

  11. Meisel A, Kuczewski M (1996) Legal and ethical myths about informed consent. Arch Intern Med 156:2521–2526

    Article  PubMed  CAS  Google Scholar 

  12. Fried TR, McGraw S, Agostini J, Tinetti ME (2008) Views of older persons with multiple morbidities on competing outcomes and clinical decision-making. J Am Geriatr Soc 56(10):1839–1944

    Article  PubMed  Google Scholar 

  13. Lo B, Steinbrook R (1991) Beyond the Cruzan case: the U.S. Supreme Court and medical practice. Ann Intern Med 114:895–901

    PubMed  CAS  Google Scholar 

  14. Calvert GM, Hornung RW, Sweeney MH, Fingerhut MA, Halperin WE (1992) Hepatic and gastrointestinal effects in an occupational cohort exposed to 2, 3, 7, 8-tetrachlorodibenzo-para-dioxin. JAMA 267(16):2209–2214

    Article  PubMed  CAS  Google Scholar 

  15. Schneiderman LJ, Spragg RG (1988) Ethical decisions in discontinuing mechanical ventilation. N Engl J Med 318:984–988

    Article  PubMed  CAS  Google Scholar 

  16. Sullivan RJ (1993) Accepting death without artificial nutrition or hydration. J Gen Intern Med 8:220–224

    Article  PubMed  Google Scholar 

  17. Applebaum PS, Grisso T (1988) Assessing patients’ capacities to consent to treatment. N Engl J Med 319:1635–1638

    Article  Google Scholar 

  18. Appelbaum PS (2007) Assessment of patients’ competence to consent to treatment. N Engl J Med 357:1834–1840

    Article  PubMed  CAS  Google Scholar 

  19. Brock DW, Wartman SA (1990) When competent patients make irrational choices. N Engl J Med 322:1595–1599

    Article  PubMed  CAS  Google Scholar 

  20. Jefferson AL, Lambe S, Moser DJ, Byerly LK, Ozonoff A, Karlawish JH (2008) Decisional capacity for research participation individuals with mild cognitive impairment. J Am Geriatr Soc 56:1236–1243

    Article  PubMed  Google Scholar 

  21. Stocking CB, Hougham GW, Danner DD, Patterson MB, Whitehouse PJ, Sachs GA (2008) Variable judgements of decisional capacity in cognitively impaired research subjects. J Am Geriatr Soc 56:1893–1897

    Article  PubMed  Google Scholar 

  22. Naik AD, Teal CR, Pavlik VN, Dyer CB, McCullougy LB (2008) Conceptual challenges and practical approaches to screen capacity for self-care and protection in vulnerable older adults. Geriatr Soc 56:S266–S270

    Article  Google Scholar 

  23. Lai J, Karlawish J (2007) Assessing the capacity to make everyday decisions: a guide for clinicians and an agenda for future research. Am J Geriatr Psychiatry 15(2):101–111

    Article  PubMed  Google Scholar 

  24. Drickamer MA (2009) Legal and ethical issues. In: Pacala JT, Sullivan GM (eds) Geriatric review syllabus: a core curriculum in geriatric medicine, 7th edn. American Geriatrics Society, New York, NY

    Google Scholar 

  25. Hastings Center (1987) Guidelines on the termination of life-sustaining treatment and the care of the dying. Indiana University Press, Bloomington, IN

    Google Scholar 

  26. Sulmasy DP, Terry PB, Weisman CS, Miller EJ, Stallings RY, Vettese MA, Haller KB (1998) The accuracy of substituted judgments in patients with terminal diagnoses. Ann Intern Med 128:621–629

    PubMed  CAS  Google Scholar 

  27. Schneiderman LJ, Pearlman RA, Kaplan RM et al (1992) Relationship of general advance directive instructions to specific life-sustaining treatment preferences in patients with serious illness. Arch Intern Med 152:2114–2122

    Article  PubMed  CAS  Google Scholar 

  28. AGS Ethics Committee (1996) Making treatment decisions for incapacitated older adults without advance directives. J Am Geriatr Soc 44:986–987

    Google Scholar 

  29. Berger JT, DeRenzo EG, Schwartz J (2008) Surrogate decision making: reconciling ethical theory and clinical practice. Ann Intern Med 149:48–53

    PubMed  Google Scholar 

  30. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T et al (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673

    Article  PubMed  CAS  Google Scholar 

  31. Smyer M, Schaie KW, Kapp MB (eds) (1996) Older adults’ decision making and the law. Springer, New York, NY

    Google Scholar 

  32. Walker RM (1991) DNR in the OR: resuscitation as an operative risk. JAMA 266:2407–2412

    Article  PubMed  CAS  Google Scholar 

  33. Gostin LO (2001) National health information privacy regulations under the Health Insurance Portability and Accountability Act. JAMA 285:3015–3021

    Article  PubMed  CAS  Google Scholar 

  34. Quill TE, Brody H (1996) Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 125:763–769

    PubMed  CAS  Google Scholar 

  35. Schneiderman LJ (1994) The futility debate: effective versus beneficial intervention. J Am Geriatr Soc 42:883–886

    PubMed  CAS  Google Scholar 

  36. Schneiderman LJ, Jecker NS, Jonsen AR (1996) Medical futility: response to critiques. Ann Intern Med 125:669–674

    PubMed  CAS  Google Scholar 

  37. White DB, Curtis R, Wolf LE, Predergast TJ et al (2007) Life support for patients without a surrogate decision maker: who decides? Ann Intern Med 147:34–40

    PubMed  Google Scholar 

  38. Knaus WA, Harrell FE, Lynn J et al (1995) The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Ann Intern Med 122:191–203

    PubMed  CAS  Google Scholar 

  39. Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system: risk predication of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636

    Article  PubMed  CAS  Google Scholar 

  40. Lynn J, Teno JM, Harrell FE Jr (1995) Accurate prognostication of death: opportunities and challenges for clinicians. West J Med 163:250–257

    PubMed  CAS  Google Scholar 

  41. Teno JM, Harrell FE, Knaus W, Phillips RS, Wu AW et al (2000) Prediction of survival for older hospitalized patients: The HELP survival model. J Am Geriatr Soc 48:S16–S24

    PubMed  CAS  Google Scholar 

  42. Christakis NA, Lamont EB (2000) Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 320:469–473

    Article  PubMed  CAS  Google Scholar 

  43. Wu AW, Yasui Y, Alzola C, Galanos AN et al (2000) Predicting functional status outcomes in hospitalized patients aged 80 years and older. J Am Geriatr Soc 48:S6–S15

    PubMed  CAS  Google Scholar 

  44. Quill TE, Meier DE, Blovk S, Billings A (1998) The debate over physician assisted suicide: empirical data and convergent views. Ann Intern Med 128:552

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine (Geriatrics), Yale University School of Medicine, 874 Howard Avenue, New Haven, CT, 06519, USA

    Margaret Drickamer

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  1. Margaret Drickamer
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Correspondence to Margaret Drickamer .

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Editors and Affiliations

  1. School of Medicine, Department of Surgery, Yale University, New Haven, 06520, Connecticut, USA

    Ronnie Ann Rosenthal

  2. Downstate Medical Center, State University of New York, Clarkson Ave. 450, Brooklyn, 11203, New York, USA

    Michael E. Zenilman

  3. , Chairman, Department of Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, 21215, Maryland, USA

    Mark R. Katlic

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Drickamer, M. (2011). Ethics in Clinical Practice. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_14

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  • DOI: https://doi.org/10.1007/978-1-4419-6999-6_14

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