CURRENT Essentials of Critical Care.pdf

Chapter 3 Ethical Issues 33■■Medical EthicsEssential Concepts• Ethical decisions based on four basic principles• Autonomy: Patient has right to make informed decisions and refusals,if has capacity to understand consequences of decisions;capacity means understanding consequences of decision• Beneficence: Care must achieve good not harm; goals of medicineare saving life, prolonging life, relieving suffering, curingdisease• Nonmaleficence: Avoid harm while meeting other goals andprinciples; at times, may conflict with beneficence• Justice: Treat fairly in relationship to others; allocate resourceswhere likely to do most goodEssentials of Management• Let patients or other decision makers make autonomous decisionsbut only after giving sufficient information and confirmingunderstanding• Care must focus on achieving goals of medicine• All options and decisions must weigh benefits against risks foreach diagnostic or therapeutic intervention• Physicians responsible to individual patient; may conflict attimes with responsibility to community (eg, costs of care, limitedresources)• Common conflicts: Patient has autonomy to make informedchoices, but physicians must not allow them to harm themselves.When striving to relieve suffering (pain), analgesia may shortenlife. Patients have right to make decisions, even if they conflictwith family members■ PearlDesignated surrogate decision makers often do not make same decisionas the patient would; prior discussion and communication greatlyimprove agreement.ReferenceHenig NR et al: Biomedical ethics and the withdrawal of advanced life support.Annu Rev Med 2001;52:79. [PMID: 11160769]