ETHICS for the USMLE examinations
This term describes the responsibility of the physician to always act in the best interest of the patient. Beneficence may not always be in place, as a patient’s right to make their own decisions may not always be in their very best interest. In this situation, the physician has a duty to honor the desires of the patient with respect to his or her own care.
This term means the physician shall “Do No Harm”, and is always priority #1 when it comes to medical ethics and practice principles.
Autonomy refers to the patient’s right to make their own decisions after being properly educated and informed. Whether a physician believes these decisions to be right or wrong, they have a duty to respect and honor the patient’s autonomy.
A PATIENT’S ABILITY TO MAKE DECISIONS
A patient’s ability to make their own decisions is based on a few principles that must be in place:
– Patient must be psychologically stable (ie not skewed by mental illness)
– Patient must be the one who tells you their desires, not the family
– Patient does not switch back and forth between their wishes (shows instability of the patient’s mentation)
– Patient receives complete information of advantages and disadvantages of treatment options
– Patient makes their choice, which is not influenced by family, friends, etc
Informed consent is when a patient gives the physician the consent to proceed with medical management. It must be based on properly informing the patient, whereby they understand the risks, benefits, and alternative options. Decisions must be based on complete autonomy, not of persuasion.
WHEN IS INFORMED CONSENT NOT REQUIRED?
It is fully legal to proceed with medical intervention without a patient’s consent when any of the following are present:
– Intervention will be life-saving, such as in the ER
– Patient is not in a mental state to make a decision (psychosis, intoxication)
– The patient waives their right to informed consent
– There is a therapeutic advantage to not getting informed consent
PATIENT’S RIGHT TO CONFIDENTIALITY
A patient has the right to complete confidentiality, whereby disclosing a patient’s information is illegal unless they give you direct permission to do so.
WHEN IS CONFIDENTIALITY BREACHABLE?
There are certain situations in which it is the physician’s responsibility to breach confidentiality for the safety of society and/or for the greater benefit of the patient.
These instances include:
– There is the potential for harm to others (Tarasoff decision)
– The patient has a high risk of self-harming
– There is the presence of a reportable infectious disease
– Patient is either suicidal or homicidal
– There is abuse to a child or an elder
THE ADVANCED DIRECTIVE
There are numerous ways by which a patient can give their advanced directive.
Living Wills – the patient informs the physician whether they want to be treated or not should the need arise where they cannot communicate this to the physician
Oral Advanced – while less likely to stand up in court, this is an oral request given by the patient to the physician in the past requesting their desires for medical intervention
DURABLE POWER OF ATTORNEY
The durable Power of Attorney is a person designated by the patient to make their medical decisions in the event that they are unable to do so for themselves.
There are four criteria that must be met in order for a malpractice suit to be warranted, they are:
Duty – This implies that there is a physician-patient relationship that is established.
Dereliction – When the physician fails to comply with the standards of care for the patient
Direct Cause – Where a patient incurs injury/damage that resulted from the physician’s breach of duty, where there are no other circumstances that may have caused the injury
Damages – The injuries suffered by the client
** It should be noted that the absolute most common reason for a medical lawsuit is a lack of communication or poor communication between the physician and patient. Establishing a strong physician-patient relationship is the best way to prevent a lawsuit.