Core Ethical Principles (Part 1)

Summary

This script delves into the four core principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. It emphasizes the importance of respecting patient autonomy, acting in their best interest (beneficence), avoiding harm (non-maleficence), and ensuring fair treatment (justice). The discussion uses real-life scenarios to illustrate ethical dilemmas, particularly the tension between autonomy and beneficence, and the difference between equal and equitable treatment in the context of justice.

Takeaways

• 📚 The four core principles of ethics are autonomy, beneficence, non-maleficence, and justice.
• 🧠 Autonomy emphasizes respecting patients as individuals and their right to make informed decisions.
• 🛡 Beneficence involves acting in the patient's best interest, which can sometimes conflict with autonomy.
• 🚫 Non-maleficence, or 'do no harm,' requires careful consideration of the risks and benefits of medical interventions.
• ⚖️ Justice in medical ethics means providing equitable treatment, not necessarily equal treatment, especially in triage situations.
• 🤔 Ethical dilemmas often arise when principles like beneficence and autonomy are at odds, requiring careful judgment.
• 🗣️ Informed consent is a critical aspect of respecting autonomy and is discussed in more detail in subsequent videos.
• 🏥 In practice, ethical principles guide healthcare providers in making decisions that balance patient rights and medical best practices.
• 👨‍⚕️ The script uses case examples to illustrate how ethical principles apply to real-world clinical scenarios.
• 📉 The principle of justice is nuanced; it focuses on fair treatment within the constraints of the medical system, not just simple equality.

Q & A

What are the four core principles of ethics in healthcare?

The four core principles of ethics in healthcare are autonomy, beneficence, non-maleficence, and justice.

What does the principle of autonomy entail in the context of patient care?

Autonomy refers to respecting patients as individuals, creating an environment conducive to informed consent, and honoring patient decision-making, assuming the choice is made with capacity.

How does the principle of beneficence conflict with autonomy in ethical dilemmas?

Beneficence, which involves acting in the patient's best interest, often conflicts with autonomy when patients make decisions that are not in their best interest, creating a challenge in ethical dilemmas.

What is the correct response when a patient with stage 1 renal cell carcinoma refuses cancer-suppressing therapy?

The correct response is to respect the patient's decision but also to inform them that not pursuing treatment is not the best course of action, balancing autonomy and beneficence.

What does the term 'non-maleficence' mean in medical ethics?

Non-maleficence means 'do no harm' and requires careful consideration of risks versus benefits, especially when performing risky procedures or invasive tests.

How is the principle of non-maleficence balanced against beneficence in medical decisions?

Non-maleficence is balanced against beneficence by weighing the potential risks of harm against the benefits of treatment or procedures, ensuring informed consent is given when risks are involved.

What is the difference between equal and equitable treatment in the context of the principle of justice?

Equal treatment implies the same treatment for all, whereas equitable treatment means fair treatment within the constraints of the medical legal system, taking into account the urgency and severity of individual cases.

Why might a patient have to wait in the emergency department while others are seen sooner?

A patient might have to wait because the principle of justice requires equitable treatment, which means prioritizing more acute or life-threatening cases over less urgent ones, even if it appears unequal.

How can a physician ensure they are upholding the principle of justice when triaging patients?

A physician can ensure they are upholding justice by following triage protocols that prioritize patients based on the severity of their condition, ensuring equitable access to care.

What is the significance of informed consent in the context of ethical principles?

Informed consent is significant as it is a process that respects a patient's autonomy by ensuring they understand the risks, benefits, and alternatives of a treatment or procedure before giving their consent.

Outlines

00:00

📚 Introduction to Core Ethical Principles

The video script introduces the four core principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. It emphasizes the importance of these principles in medical practice and education, noting that while the principles themselves are straightforward, applying them to real-world scenarios can be challenging. The script uses examples to illustrate how these principles might come into conflict, particularly between autonomy (respecting a patient's individual choices) and beneficence (acting in the patient's best interest). The discussion highlights the complexity of ethical decision-making in healthcare.

05:00

🏥 Ethical Dilemma: Balancing Autonomy and Beneficence

This section of the script delves into a specific ethical dilemma involving a patient with stage 1 renal cell carcinoma who refuses treatment. The physician must balance respecting the patient's autonomy with the principle of beneficence, which requires acting in the patient's best interest. The script explains why certain responses to the patient's decision are inappropriate, such as offering false hope or failing to inform the patient of the risks and benefits of treatment. The correct approach, as per the script, is to acknowledge the patient's decision while also communicating the physician's obligation to inform them that refusing treatment may not be the best course of action.

10:01

🚑 Non-Maleficence and Beneficence in Medical Decisions

The script discusses the principle of non-maleficence, which dictates that physicians should 'do no harm.' It contrasts this with beneficence, which involves promoting the patient's well-being. An example is provided of a patient needing a liver biopsy, where the physician must weigh the risks (non-maleficence) against the potential benefits (beneficence). The script clarifies that while physicians must inform patients of the risks and benefits, they should avoid making overly general statements about treatment outcomes and instead focus on specific data and the patient's individual circumstances.

🔄 Equity in Healthcare: The Principle of Justice

The final section of the script addresses the principle of justice in healthcare, which involves treating patients fairly. It uses a scenario where a patient with non-acute symptoms is made to wait while others with more urgent needs are treated first. The script explains that justice in this context means equitable treatment, not necessarily equal treatment. The triage system is highlighted as an example of equitable treatment, where patients are prioritized based on the severity of their conditions, ensuring that resources are allocated fairly according to medical need.

Keywords

💡Autonomy

Autonomy refers to the principle of respecting patients as individuals and their right to make their own decisions. In the video, it is emphasized that healthcare providers must create an environment that supports informed consent, which is a key aspect of respecting autonomy. The video uses the term 'auto' from words like 'automatic' to illustrate the concept of self, which is central to autonomy. An example from the script involves a patient with cancer who chooses not to engage in cancer-suppressing therapy, demonstrating the healthcare provider's obligation to respect the patient's decision-making capacity.

💡Beneficence

Beneficence is the ethical principle of acting in the patient's best interest. The video explains that this principle often conflicts with autonomy because patients may make choices that are not in their best health interest. An example given is a scenario where a patient with treatable stage one cancer refuses treatment, and the healthcare provider must balance respecting the patient's autonomy with the obligation to act in the patient's best interest by informing them that refusing treatment is not the best course of action.

💡Non-maleficence

Non-maleficence, derived from the Latin 'non' meaning 'not' and 'maleficence' meaning 'evil' or 'harm', is the principle of 'do no harm'. The video discusses how this principle requires careful consideration of the risks versus benefits of a medical intervention. It is illustrated through a scenario where a patient is recommended for a liver biopsy, and the healthcare provider must explain the risks and benefits, ensuring that the patient is fully informed before consenting to the procedure.

💡Justice

Justice in the context of medical ethics refers to treating people fairly. The video clarifies an important distinction between equal and equitable treatment. It uses a scenario where a patient with GERD waits for a long time in the emergency department while others are seen sooner, to explain that justice is served when treatment is equitable, not necessarily equal. This means that the healthcare system should prioritize patients based on the severity of their conditions, which may result in different waiting times but is fair within the constraints of the medical system.

💡Informed Consent

Informed consent is a process where a patient is given sufficient information about a medical procedure or treatment, including its risks and benefits, to make an informed decision about whether to proceed. The video emphasizes that informed consent is crucial for upholding the principle of autonomy. It is mentioned multiple times as a process that healthcare providers must facilitate to ensure patients can make decisions that respect their autonomy.

💡Capacity

Capacity in the video refers to a patient's ability to make decisions about their healthcare. It is mentioned as a criterion that must be met for a patient's decision to be respected under the principle of autonomy. The video explains that patients must be able to explain their decision-making process in a logical and linear fashion to be considered as having capacity.

💡Ethics Committee

An Ethics Committee is a group within a healthcare institution that deals with ethical issues and dilemmas. In the video, it is mentioned as a potential resource when ethical dilemmas arise that cannot be resolved through standard decision-making processes. The video cautions against automatically referring to an Ethics Committee, suggesting it should only be considered in unique or complex cases.

💡Triage

Triage is the process of determining the priority of patients' treatments based on the severity of their conditions. The video uses the concept of triage to illustrate the principle of justice, explaining that while it may seem unfair for some patients to wait longer than others, the system of triage ensures equitable treatment by prioritizing those most in need.

💡Ethical Dilemma

An ethical dilemma is a situation that requires a choice between options that involve conflicting principles of ethics. The video discusses several ethical dilemmas, such as the conflict between autonomy and beneficence, where a patient's right to make their own decisions may conflict with what is considered to be in their best medical interest.

💡Risks vs. Benefits

Risks vs. Benefits is a concept used to evaluate medical interventions, weighing the potential harms against the potential advantages. The video explains that this evaluation is crucial for the principle of non-maleficence, where the goal is to do no harm. It is illustrated through the example of a liver biopsy, where the healthcare provider must ensure the patient understands both the risks and benefits before proceeding.

Highlights

Introduction to the four core principles of ethics: autonomy, beneficence, non-maleficence, and justice.

Explanation of autonomy as respecting patients' individual rights and informed consent.

Beneficence is described as acting in the patient's best interest, often conflicting with autonomy.

An example scenario involving a patient with renal cell carcinoma refusing treatment to illustrate beneficence versus autonomy.

The correct response to the patient's refusal of treatment, emphasizing beneficence over autonomy.

Non-maleficence is introduced as the principle of 'do no harm' and requires a careful risk-benefit analysis.

A practice question contrasting non-maleficence with beneficence in the context of a liver biopsy.

The importance of informed consent in balancing non-maleficence and beneficence.

Introduction to the principle of justice, emphasizing equitable treatment over equal treatment.

A scenario in the emergency department to illustrate the concept of equitable treatment versus equal treatment.

The distinction between equitable and equal treatment in the context of justice.

The importance of understanding that triage is not an exception to justice, but part of equitable treatment.

Summary of the four core ethical principles and their practical application in medical ethics.

Emphasis on the difficulty of applying ethical theories to real-world scenarios in medical practice.

Advice on how to approach ethical questions, especially when principles conflict.

Encouragement to watch the rest of the lecture series for a deeper understanding of ethics.

Transcripts

now you've probably seen these core

principles before and they're extremely

important and that's why they're always

the first little bit of information

that comes up in any review textbook or

question bank

when you're learning ethics the four

core principles of ethics

are autonomy beneficence non-maleficence

and justice and we're going to go

through each of these one at a time

and i'll use some examples of

challenging scenarios

or questions that you might see about

these core principles

and if we can just pause for one second

as a

bigger theme of ethics what you'll

notice is that

the material itself isn't that hard to

learn right there's very

finite amount of information when it

comes to learning ethics but what's

really challenging

is applying those you know the theory of

ethics and what we should be doing

to actual questions because oftentimes

with ethical questions

there'll be a couple answers that sound

really good and really convincing

and it will be very very difficult to

choose between them

so as we go through these examples and

as we go through this entire

dirty ethics series i'll do my best to

point out what you should keep in mind

when you're answering questions

so let's get started with the four

ethical principles the first

one is autonomy so autonomy refers to

respecting patients as individuals right

so you respect each patient

as their own individual it requires that

you create an environment that's

conducive to informed

consent and you're going to see the word

informed consent pop up a lot in this

lecture

and it's actually going to be the second

video in dirty ethics so see the next

video in this lesson series to get more

information about informed consent

autonomy also it refers to honoring

patient decision making regardless of

what their choice is

assuming that this choice is made with

capacity

and we'll get into what capacity is in a

future video as well

so that's autonomy now if you're

confused about what autonomy means and

you're not really

good at understanding it by referring to

these bullet points

look at the word itself auto means self

right

automatic driving car is a self-driving

car

right auto digestion is self-digestion

so

look at the prefix of these words if

you're having trouble remembering what

the ethical principle

refers to so it means self and again

autonomy is respecting patients as

individuals or respecting them as their

individual selves

so very very important the next ethical

principle is beneficence and this is

acting in the patient's best interest

and on exams this usually conflicts with

the principle of autonomy and that's the

reason

that ethical questions about beneficence

are actually pretty challenging so we're

going to focus on this point

in red that on exams beneficence

usually conflicts with the principle of

autonomy so i want to use an example to

show

you how this might come up so here's our

example

a 39 year old white male with a past

medical history of renal cell carcinoma

currently stage 1 is seen in the

oncology office

he says that he does not want to engage

in cancer suppressing therapy

and does not want to hear about

chemotherapy or radiation

or resection he is content to die

the patient is judged to have full

capacity in making this decision

which of the following is the best

response so before i even read the

different answer choices here let's

just really quickly highlight what this

question is saying so we've got a guy

who has

a cancer in his kidney it's currently

stage one

he's not interested in hearing about

treatment options and he's very much

willing to die

at some point it looks like the

physician who's

you know explaining everything to him

judge this patient to have full capacity

in making this decision

so now the question is which of the

following is the best response

a i respect your decision but tell me

how you arrived at this decision

b i respect your decision but medically

there's hope to treat this

c i respect your decision but it is my

obligation to tell you that this is not

the best course of action

d we will not proceed with any further

treatment

e i will be forced to discuss your

choice with the ethics committee

now a lot of these answers seem pretty

good right i mean if you're if you're

the physician in real life you might say

a combination of these things but on a

test there's one

answer okay there's one answer now you

know what a lot of you

are leaning towards right now you're

probably leaning towards choice a but

this is not the correct answer because

in the question the patient was already

judged to have full capacity and we're

going to get into capacity in a future

video but

as one of the criteria of capacity the

patient has to explain to you

in a seemingly logical and linear

fashion how they arrived at their

decision

so a would be redundant because they've

already told you how they have arrived

at that decision

since you judged them to have capacity

so the correct answer here is actually c

and if you if you read c it says i

respect your decision but it's my

obligation to tell you that this is not

the best course of action so obviously

the question was

hinting that this is stage one it's

treatable but the patient simply doesn't

want to hear any treatment options

okay so you as the physician have the

obligation to

act in the patient's best interest which

is the principle of beneficence in

telling them

that i respect your decision right

you're respecting their autonomy

but it's your obligation to tell them

that this is not the best course of

action so while you're respecting them

because of the principle of autonomy and

letting them act as a self

you also have to maintain the principle

of beneficence and

act in their best interest by telling

them that this is not the best course of

action

the reason that b is not the correct

answer is because you never want to give

somebody hope that something something's

going to be treated or cured

you can say that you know you can cite

data and say what the treatment outcomes

are and what the prognosis is

but a general statement such as but

medically there's hope to treat this

general statements like that are never

going to be the right answer on ethics

questions so avoid those generalities

d we will not proceed with any further

treatment technically that's right

because the patient has capacity

and you know you're going to respect

their decision because you're going to

respect their autonomy

but you have to throw in this little

qualifier that it's your obligation to

tell them that it's not the best course

of action

because if you just say we will not

proceed with any further treatment

then you're kind of like lacking

beneficence a little bit because but

you're not acting in the patient's best

interest if you don't tell them

that this this is not the best course of

action you have that obligation

and then e i will be forced to discuss

your choice with the ethics committee

anytime you see ethics committee it's

probably not the right answer it's only

the right answer in one

very unique case which we'll get into in

a future video

but again the gist of this question is

that oftentimes beneficence which is

acting in the patient's best interest is

going to be at odds with autonomy

where you're allowing the patient to

make their own decisions because

oftentimes they're going to make

decisions

that are not in their best interest so

again the only point of this question

was to show you

that beneficence and autonomy are

oftentimes on exams going to be at odds

with one another

the next ethical principle is

non-maleficence

non-maleficence refers to the do no harm

thing you know the oath that you swore

in medical school do no harm

non-maleficence requires careful

consideration of risks versus benefits

it demands informed consent be given to

a patient if a risky procedure is

attempted

now let's look at the word right non

means no and maleficence means

like evil or bad or you know terrible so

non-maleficence literally means

no bad so this is do no harm or do no

bad

let's look at a practice question that's

going to highlight

what uh non-maleficence is oftentimes

juggled against so here's our example a

56 year old hispanic female is found to

have elevated lfts on routine screening

she is recommended to undergo a liver

biopsy as part of the informed consent

process she has explained all of the

pertinent information

the explanation of risks versus benefits

in this situation

is carefully balancing which ethical

principles

a non-maleficence versus autonomy b

non-maleficence versus beneficence c

non-maleficence versus justice d

non-maleficence versus both beneficence

and autonomy

or e non-maleficence versus both

beneficence and justice

so the answer here is b it's

non-maleficence versus beneficence so

here's here's what's going on when you

non-maleficence means do no harm so

whenever you're going to do some risky

procedure or some invasive test

you have to weigh the risks versus

benefits right the risk of doing harm

against the benefit of that treatment or

that invasive procedure doing something

beneficial for the patient

so acting in the patient's best interest

and

allowing them to confer benefits is

beneficence

but non-maleficence and your desire to

do no harm

is worrying about the risks and

explaining that in the informed consent

process

so often times on exams you're going to

have to balance non-maleficence or do no

harm

against beneficence and acting in the

patient's best interest

right it's deciding when is something

medically necessary even if there is a

risk

of harming the patient in doing so so

oftentimes this is the dilemma that

you're gonna see on exams so keep this

in mind

our fourth and final core ethical

principle is justice and simply put

justice is treating

people fairly now there's one minor

little stipulation that we have to make

about justice and i'm going to use a

practice question

to illustrate it to you and hopefully

you never forget it after this

so a 28 year old black male with a past

medical history

of gerd is seen in the ed waiting room

complaining of bloating and gas

he's concerned that he has a bowel

obstruction he's triaged by the ed

staff and he waits in the waiting room

for the next three and a half hours

as he's sitting there he sees other

patients who arrived after him

coming in and going straight back into

the emergency room

in this situation is the ethical

principle of justice

being upheld and being served for this

patient who's forced to wait in the

waiting room while he watches other

patients go straight back

a no this patient's treatment is not

equal

b no this treatment this patient's

treatment is not equitable

c yes triage is an exception to justice

d yes this patient's treatment is equal

e yes this treatment this patient's

treatment is

equitable so obviously as you can see

here i'm being a little nitpicky but i

want to use this to illustrate a very

important point

so the answer here is e yes justice is

being served and the reason that it's

being served

is that this patient's treatment is

equitable so justice

requires equitable treatment not equal

treatment so equitable means

like you're offered the same thing under

the law right

you're offered the same opportunity

within the constraints of the

medical legal system so when triage is

is the situation it's the hospital's

duty

to take patients back to the emergency

department that have more acute

complaints right chest pain

ruling out mis pneumothorax things that

are acutely

life-threatening and in that triage

process

everybody has equitable treatment

because when this gentleman came into

the room he was also triaged and

he was given that equitable treatment

and if it was something theoretically

that was life-threatening

he would have been taken right back but

he didn't because he's got to sit and

wait for a bed because

those beds that are open have to go to

the acutely

life-threatening situations now this is

called equitable treatment because it's

equitable under the medical legal system

it doesn't necessarily have to be equal

because in this case it's not

in this situation it's not equal right

he didn't go back but the other patient

did so that is not

equal that is inequal but justice

doesn't require equality

it requires equitability and c is not

correct because triage is not an

exception to justice justice is still

being served here

they're still treating people equitably

so justice requires equitable treatment

not equal treatment very very important

to understand that distinction

so that is the end of the first lesson

in dirty ethics as a quick summary we

went over the four

core ethical principles including

autonomy beneficence

non-maleficence and justice we used some

practice questions as we went through to

illustrate some high-yield principles

and see the rest of this lecture series

for more information

about ethics