Ethical Decisions in Healthcare

Average citizens are faced with ethical decisions every day, but arguably none more so than doctors and nurses who must deal with split-second life-and-death decisions on a regular basis. A strict code of ethics is set out by the American Medical Association, but by its very nature, an ethical choice cannot be quantified across a group of people. Although each medical decision comes with its own background, some general ethical issues are especially important in healthcare.

Assisted Suicide

• Is it right for a doctor to help a terminal patient end their suffering in a painless way, or is this act just murder by another name? Much controversy exists in both the U.S. and Europe regarding people going to states or countries purely because assisted suicide is allowed in that particular area. The most important ethical problem in this dilemma is who makes the decision. If it's the patient's decision, a judgment must be made if he is in a frame of mind that allows him to make the decision in a logical manner; alternately, if it's someone else's decision, does she have ulterior motives for wanting to end the patient's life?

Late-Term Abortion

• Late-term abortion is not illegal, so it should not register as an ethical choice. But it remains a problem in the U.S. because any form of abortion is controversial in certain regions of the country. If a pregnant woman comes in for emergency surgery unrelated to the pregnancy, doctors may have to choose to abort the child to save the mother due to the nature of the operation or anesthetics. This decision may have to be made after the cut-off point for an early abortion, or made in contradiction to the patient's, or even the doctor's, religious views.

End of Life

• As with assisted suicide, the question of who makes the decision of when to turn off a life-support device is an ethical problem. Before surgery, some patients may make it clear they do not want to be kept on life support if something goes wrong, while others may make the opposite choice. Some may not get the chance to make any kind of decision. Keeping someone on life support is expensive for the hospital and the patient, and no guarantee exists that the patient will ever recover. How long should the machine be kept on; how much will it cost; and who makes the decision -- all these questions make end-of-life decisions a complex issue.

Healthcare for Profit

• In the U.S., the vast majority of healthcare is carried out through insurance companies, and hospitals are typically run for profit. In countries with free universal healthcare and in certain demographics in America, the idea of paying for or having an insurance company decide if treatment can be offered is a serious issue. Is it right that a patient can be refused treatment just because their healthcare policy does not cover a procedure, or should you be faced with having to sell your house to pay for a lifesaving procedure? And, at what point is a doctor's Hippocratic oath overshadowed by fiscal issues?

Confidentiality

• Doctor-patient confidentiality is a key ethical issue in healthcare. Doctors cannot share patient information with just anybody, but at what point is this line drawn? Discussing a patient's treatment with her spouse or children is one thing, but at what point do the legal and public interest issues outweigh this right?

Legal Responsibility

• Many, sometimes high-profile, cases have occurred where a patient, or relatives of patients, have sued doctors and hospitals for negligence or inadequate care. Obviously, if a lapse in care has occurred, and somebody has died as a result of negligence, questions need to be answered. The ethical element of this situation arises when people sue purely because they can. These cases can ruin a doctor's career and the hospital's reputation when they have not necessarily done anything wrong. The question in this instance is at what point does a medical malpractice suit become a distraction and possibly play in to, by necessity, a doctor's decision process.

Treatment of Family Members

• The American Medical Association (AMA) code of ethics clearly states a doctor is not allowed to treat family members. The reason for this ruling is that decisions may be clouded by the emotional aspects of treating these people. The question here again is at what point is the line drawn. Is it okay for a doctor to treat a relative for a minor injury, for example, a broken bone, and not be involved with diagnostic treatment for more serious illnesses.