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Ethical Dilemmas Doctors Have to Confront

The ethics and professionalism in medicine are of core importance when it comes to the role of the physician in his code of conduct.

With the great prestige and nobility in this profession comes the great responsibility in doctor’s hand, as they have to go through quandary in situations when it comes to cases like euthanasia, abortion, making a decision of who even makes it onto a waiting list for organ transplant, quick and life-changing decisions, psychological pressure from the loved ones of the patient, the patients family blame the doctors if the patient is unable to make during surgery, they should understand that death is imminent and the doctors do, whatever they can to save a life.

The doctor must explain the procedure to the patient and give him full information about the benefits, risks, positive and negative effects, leaving up to the patient to make the choice about undergoing the surgical procedure. The doctor should not perform the surgical intervention, only taking into consideration his personal gains and benefits. His first priority always has to be the patients’ health and to act in the best interest to protect the patient from any kind of harm. The doctor should be impartial when it comes to the selection of deserving cases and their needs, and on the basis of their degree of sickness.

The one of the most important and foremost ethical concern is taking an informed consent. Informed Consent is taken in advance from the patient, it is an agreement or a gesture to permit the doctor to have his medical history, undergo examination procedure, diagnosis, treatment, and intervention. The patient should be competent, well aware; mentally and emotionally stable. In some cases, the patient in spite, of his serious condition, refuse to agree with the intervention or surgical procedure, where then doctors have to make a decision for the welfare of the patient.

The information of the patient can only be breached if:

  1. himself asks the physician.
  2. In the case of children, the information is conveyed to the parents; as they are very
    young to handle their condition.
  3. There is a need of the help of the healthcare team in solving the case. Whether, the disclosure is for the criminal investigation of crime or harm to others, assault case, protecting the vulnerable; such as in child abuse case.
  4. For research purposes but only as anonymous and after taking consent from the patient.
  5. When it comes to public interests it may be breached when a patient has a highly contagious disease such as tuberculosis; the doctor has to inform the patients family so that precautionary measures can be taken. If the patient has a sexually transmitted disease, let’s say HIV which is a communicable disease, the doctor may disclose his disease to his partner in order to protect from the risk of getting the disease.
  6. State registries where officials keep track of cases like diabetes, cancer, HIV/AIDS, Alzheimer disease, Amyotrophic lateral sclerosis, and many other diseases.

It is the duty of the doctor to act in his best interest while dealing with a case, abide by the principles in common clinical situations, and work in the beneficence of the patient and do no harm in the treatment procedure.
The common ethical conundrums that doctors’ have to face in their course of profession:-

1- Euthanasia:

Euthanasia or physician-assisted suicide is considered as one of the supreme problems when it comes to ethics of patients treatment. The decision of euthanasia by the patient or his family is made in order to reduce the suffering of the patient in his terminal sickness. It can be voluntary or involuntary. When the patient makes a decision, it is voluntary. When the physician makes a decision it is involuntary. However, may it be voluntary or involuntary, it is unethical.

The World Medical Association issued the following declaration on euthanasia:-

“Euthanasia, that is the act of deliberately ending the life of a patient, even at his own request or at the request of his close relatives, is unethical. This does not prevent the physician from respecting the will of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.”

2- Staying within their boundaries:

Doctors have to work long hours, off work, and even operate in odd hours in hospital settings and have to treat patients irrespective of their age, gender, and other attributes. They have to work in coordination with other staff members, the nurses, anesthesiologist, interns, assistants and many related members. Personal relationship or intimate relationship between the doctor and any other member like, his fellow, intern, other staff member is unethical and is prohibited. Patients often offer gifts to the doctors when their treatment intervention has been successful, or when the surgery goes well. It is quite fine, to accept those gifts as long as they are in the form of sweets or bouquet. The patient who brings gifts during the intervention may cause trouble, it may be the sign the patient needs more of the doctors’ attention. The physician should simply show reluctance to such presents and should not accept them by justifying that its’ against the ethics of their respective field.

3- Organ transplant:

Unfortunately, the availability of the transplant organs is far less, than their demand. Doctors have to make a tough decision here, that who will receive the next available organ and who will not, keeping in view the whole scenario, and what criteria is used for determining the donor. The surgeon should opt to give the transplant organ to the deserving patient on the list, on the basis of his health condition.

The physician should be approachable, equitable, able to communicate effectively and compassionately respecting the dignity of the patient regardless of his race, ethnicity, cast, choice of lifestyle. He should be dedicated to his profession, attenuate the pain of the patient by all means, preserving the health and enhancing the quality of life.