Ethical principles in medical practice

The practice of medicine is regarded as an honourable enterprise due to its emphasis on serving humanity and promoting public health. In addition to being equipped with a combination of clinical expertise, technical skill [where applicable], and interpersonal skill, the medical practitioner is expected to act with moral integrity. The moral and ethical principles, common to all mankind, expounded in ancient Greek philosophical thought, was first integrated with medical practice by Hippocrates {5" Century BCE] in an attempt at enhancing professional standards. With the passage of time, medical ethics were formulated into codes and oaths [e. g. Hippocratic Oath], and in 1803, the English Physician, Thomas Percival, founded the modern ethical principles in medical practice.

- BY Dr. SIRI GALHENAGE

Beneficence, nonmaleficence, autonomy and justice have gained acceptance as the four ethical principles of medical practice — the first two advocated by Hippocrates —“to help and do no harm” — and the latter two developed with the passage of time.

The following overview of ethical principles in medical practice was written in view of recent media reports of alleged transgressions in ethical conduct by some medical practitioners. It was written with the intention of raising awareness of the general reader and the student of medicine:

BENEFICENCE

In the medical context, the term beneficence {Latin: facere: ‘to do’, bene: good] refers to the obligation of medical practitioners to act ina manner beneficial to their patients and promote their welfare: ‘to provide competent and trustworthy service’; and ‘to act with empathy and kindness’. The term also applies to the role played by healthcare facilities — state and private.

NONMALEFICENCE

In contrast to beneficence, which is a ‘positive requirement’, nonmaleficence refers to ‘first do no harm’ (Latin: male: ‘harm’, ‘evil’]. From a medical perspective, it refers to the need to refrain from ‘unnecessary and unjustified’ therapeutic interventions.

AUTONOMY

According to the moral theory of German philosopher Immanuel Kant [1724-1804], autonomy [self-determination] stood for the ideal of ‘free will driven to action by rational thought, and not determined by an inner desire or by an external force [coercion]’. In its application to clinical practice, the medical practitioner is obliged to disclose all relevant medical findings and treatment options in order for the patient to have a role in decision-making, and exercise his/her right to self-determination. It requires the application of codes of practice such as informed consent, truth-telling and confidentiality, which are based on the right of self-determination; but not without challenges.