THE PATIENT STUDY IN FAMILY MEDICINE ETHICS

The Patient Study In Family Medicine Ethics

The Patient Study In Family Medicine Ethics

Aim:

The aim of the patient study in medical ethics is to sensitise you to the ethical dilemmas prevalent in everyday clinical practice so that you are able to identify and deal with these dilemmas competently, responsibly and with justification.

Objectives:

To enable you to:

Identify an ethical problem in clinical practice;

Articulate such a dilemma;

Develop a problem solving approach incorporating medical, legal and ethical foundations;

Arrive at possible solutions;

Implement such solutions.

Research methods

This research draws on qualitative research from two studies with families affected by HIV and AIDS. A comparative study explored the experiences of children caring for parents/relatives with HIV in Tanzania and the UK4 while an ethnographic study examined the livelihood and social impacts of HIV and AIDS care in Namibia (Thomas, 2006).

Ethical Problem In Clinical Practice

Ethical problems as consequences of evidence-based medicine (EBM) have insufficiently been investigated and discussed. EBM--as initially intended--is usually interpreted as an attempt to treat patients individually with respect to their personal preferences and the present situation according to the best available clinical evidence. This practice is in line with accepted medical ethics. Therefore, it does not appear to be a relevant issue for discussion at first sight. However, between the theoretical concept and the practical use (or misuse) of this approach discrepancies exist which require some considerations. In particular the practical use of EBM generates a number of ethical problems: EBM is increasingly misused as an instrument of resource-allocation. Based on randomized controlled trials (RCTs) for very specific patient groups, the general access to medical supply is regulated and limited.

Medical

There are three widely recognized principles in American bioethics that apply to both clinical and research ethics: respect for persons, beneficence, and justice.(1-3) Respect for persons entails respecting the decisions of autonomous persons and protecting persons who lack decisionmaking capacity and therefore are not autonomous. It also imposes an obligation to treat persons with respect by maintaining confidences and keeping promises.(1-3) Beneficence imposes a positive obligation to act in the best interests of patients or research participants. It often is understood to require that the risks of research be minimized and that the risks be acceptable in light of the potential benefits of research.(1-3) Finally, justice requires that people be treated fairly. It is often understood to require that benefits and burdens be distributed fairly within society.(1-3)

Legal

Exceptions to the legal and ethical obligation to maintain the confidentiality of HIV-related information exist. For example, health care providers in the U.S. have a duty to report HIV infections and AIDS cases to public health authorities. The benefits to the public health of this reporting are felt to outweigh the risk to individuals.(9) Reporting of AIDS cases has always included the patient's name and other identifying information. Although reporting of HIV infections initially was not done by name, there has been a recent and controversial movement in the U.S. toward name-based reporting of HIV infection.(10) The debate over name-based reporting has focused on ...