Term Paper: Medical Ethics and Decision Making

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[. . .] Doctors are often conflicted emotionally by this because their ethics and morals conflict with what they can do for their patients (Goold, 2001).

It is becoming more clear that doctors need more guidelines when it comes to delicate situations involving their patients, because they often have to go on only what they are taught in medical school and do not get to exercise their ethical beliefs as much as they would like (Rhodes, 1986). In other words, they often do not have the power to try to help their patients in the best way possible because they are unaware of some of the options that they have or are not able to find a way to get the procedure, tests, or medication covered by the health plan that the patient has (Stromwall, 2002). Concern for cost is, of course, important, but quality is more significant, and balancing these two issues fairly and completely is something that must be dealt with when the quality assessment and quality improvement issues are studied (Cox, 2002).

One of the most important issues, however, when it comes to quality and patient care, has to do with accountability (Doherty, 1995). Doctors are generally accountable to the hospital that they are associated with, and to the governing board that issued their medical license (Estroff, 1995). The changing regulations that are being considered when it comes to quality will have the doctors finding themselves accountable to the patients as well, and to other consumers such as potential patients and employers that are considering a company health plan (Faulkner & Faulkner, 1997). This is very significant because doctors will have much more to consider when it comes to their beliefs and opinions about quality health care and how best to provide it (Faulkner & Faulkner, 1997).

Some of the things that could be provided to consumers include mortality rates and information collected from surveys about patient satisfaction (Faulkner & Faulkner, 1997). This information could be important for those deciding which doctor they want to make their own (Faulkner & Faulkner, 1997). Important to this is the long-held belief that the doctor knows best and the patient should simply do what he or she is told (Faulkner & Faulkner, 1997). Now that more people are taking charge of their own health care and learning about their conditions and symptoms, more doctors are finding that what they have to say is being questioned (Faulkner & Faulkner, 1997). Some welcome this, as it helps them to keep up with what is going on, but others feel as though their abilities and decisions are being questioned, and they are often uncomfortable with patients who appear to know more about certain medications and conditions than the doctors themselves (Faulkner & Faulkner, 1997).

These doctors could learn much from their patients, but they choose not to, and whether their behavior is ethical or moral, it certainly does not help them or their patients to learn more about what they need to protect their health and livelihood (Faulkner & Faulkner, 1997). Coming along with the quality concerns is the issue of patients' rights (Irving & Young, 2002). Patients' rights became big several years ago when increasing numbers of patients began to think that perhaps they were not getting everything that they should at their doctor's office, and many of them were disenchanted with the treatment that they were receiving (Faulkner & Faulkner, 1997). Applying patients' rights and quality assessments to medical ethics and morals is something that is relatively new, but it has sprung from patients' rights complaints of the past and the concern for quality assessments and improvements of the health care system in general (Faulkner & Faulkner, 1997).

Controversial Issues and Ethical Behavior

Both of these causes, as has been mentioned, have their own individual degrees of importance (Hartman, 1993). However, when they are combined they are very powerful, and doctors, hospitals, and others in the medical profession have not been able to ignore them (Hartman, 1993). This has been especially true in areas such as abortion and assisted suicide (Hartman, 1993).

These areas are already having their own difficulties because of the controversy that surrounds them, and this controversy is made stronger when doctors have difficulties with them due to ethical and moral beliefs and opinions (Hartman, 1993). Peer pressure, family attitudes, and religious views can all affect how a particular doctor feels about his or her practice and the procedures that he or she is asked to perform (Hartman, 1993).

Generally, doctors that have objections to a particular procedure, such as abortion, will not undertake any type of medicine where this may be necessary, but sometimes they are asked to perform a service or recommend someone who can, and their moral and ethical beliefs can affect the decision that they make for their patient (Hartman, 1993). There is some concern about this, as different doctors share different opinions and beliefs, and they must do all that they can for their patients but ensure that they do what they feel is morally right, as well (Hartman, 1993).

Sometimes, these things conflict and when they do the doctor has trouble finding a happy medium between what he knows he should do for the patient and what he feels is right morally, ethically, and religiously (Hartman, 1993). The question then arises as to whether there should be more guidelines for these doctors to follow (Hartman, 1993). Having more guidelines for these sensitive issues will help these doctors to be aware of what they must do and how they can reconcile these requirements for their practices with what they believe in (Hartman, 1993).

Until recently, there has not been much interest in using the assessment and improvement techniques that come with quality to deal with ethics and morals, because these things are thought to be personal and not something that the medical community can be forced to impose regulations over (Hartman, 1993). However, when something affects the health of the patients, then it becomes the concern of the medical community and must be dealt with accordingly (Hartman, 1993). This concern for ethics expands not only to doctors, but also to hospitals and health care plans, as they are all involved in the ethical and moral dilemmas that are sometimes faced and in the care of the patients that they deal with (Hartman, 1993).

There are some that wonder why anyone should be so concerned about using quality assessment for medical ethics and accountability, but it has become a very large problem for many patients, and as an extension of that, a problem for doctors and other medical professionals (Hartman, 1993). It has gotten to such a point that something must be done to correct it. The real answer to that question of 'why?', however, lies in the field of bioethics and how much it has progressed since the Second World War (Hartman, 1993). Those that work in the field talk of the rights of patients, but the field has been very slow to insist on changing anything regarding its behavior and has not given any kind of accountability for the quality of their ethics practices to consumers (Hartman, 1993).


There are many aspirational standards for those in the field of bioethics, and those who work in that field usually work toward those standards instead of looking at their actual behavior from an ethical standpoint and looking for ways to change their profession so that ethics is not such a large concern as it currently is (Freedman & Combs, 1996). These high standards are still important today, but recently some in the field have begun to see that legal requirements and enforcement are also highly important (Fitzgerald, 1989). Much of this applies to what is now being done with experimentation, cloning, and other highly controversial procedures, but there are also applications to some of the more accepted but still controversial issues of the day, such as assisted suicide, abortion, and plastic surgery (Hartman, 1993).

Where assisted suicide, also sometimes called euthanasia, is concerned, there is not as much need for discussion because there has not been as much acceptance of the practice (Hartman, 1993). Ethics are still a concern for this issue, but the lack of acceptance has made assisted suicide something that is not often discussed and is not widely practiced (Hartman, 1993).

Based on this, there have not been serious demands about ethical guidelines for the practice, other than to argue whether the practice itself should be considered ethical when the goal of the doctor should be to prolong life, not find a way to help end it (Hartman, 1993). However, those that believe in assisted suicide argue that a good death is often more important to a terminally ill patient than a prolonging of a life that is painful, uncomfortable, and will undoubtedly end soon anyway (Hartman, 1993). The feelings and beliefs of the doctor have much to do with whether he or… [END OF PREVIEW]

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