Question

• Discuss the ethical principles.
• Provide an example, related to healthcare, for each ethical principle.

Answer 1

Ethical principles are part of a normative theory that justifies or defends moral rules and/or moral judgments; they are not dependent on one's subjective viewpoints. Ethical principles in public health practice refer to those general judgments that serve as a basic justification for the many particular ethical prescriptions and evaluations of public health activities.

Four basic ethical principles are commonly accepted. These principles include (1) autonomy, (2) beneficence, (3) nonmaleficence, and (4) justice. For Case managers, and other health professionals, veracity (truthfulness) and fidelity (trust) are also spoken of as ethical principles but they are not part of the foundational ethical principles identified by bioethicists

1.autonomy

It is the ability to make decisions for oneself, also known as self-government. We hold great respect for individual rights and equate freedom with autonomy.Respect for autonomy requires that patients be told the truth about their condition and be informed about the risks and benefits of treatment in order for them to make informed decisions. Under the law, they are permitted to refuse treatment even if the best and most reliable information indicates that treatment would be beneficial, unless their action may have a negative impact on the well-being of another individual.a healthcare personal or any other member can't take unilateral decision in patient care.

Example if a physician and relataves taking a decision for ambutation of diabetic patient foot which is gangrene and peripheral obstructive disease.without patient awareness and consent it is ethical principle violation. It is illegal.

2.

The Principle of Beneficence
The beneficent practitioner provides care that is in the best interest of the patient. Beneficence is the act of being kind. The actions of the healthcare provider are designed to bring about a positive outcome. Beneficence always raises the question of subjective and objective determinations, of benefit versus harm. A beneficent decision can only be objective if the same decision would be made regardless of who was making it.

Traditionally the ethical decision-making process and the ultimate decision were the determination of the physician. This is no longer the case; the patient and other healthcare providers, according to their specific expertise, are central to the decision-making process. For example, case managers have expertise in quality-of-life issues, and in this capacity can offer much to the discussions of lifestyle and life-challenging choices, particularly when dealing with terminal diseases and end-of-life dilemmas

3.The Principle of Nonmaleficence
Nonmaleficence means doing no harm. Providers must ask themselves whether their actions may harm the patient either by omission or commission.Actions or practices of a healthcare provider are “right” as long as they are in the interest of the patient and avoid negative consequences.

Harm by an act of omission means that some action could have been done to avoid harm but wasn’t done. Omission would be failing to raise the side rails on the patient’s hospital bed, upon which the patient fell out and was injured. An act of Commission is something actually done that resulted in harm. An example of an act of commission would be delivering a medication in the wrong dose or to the wrong patient.

Case managers can be accused of maleficence by omission if they failed to coordinate a patient’s care correctly—for example, discharging a patient to an inappropriate level of care or leaving a patient in a dangerous living situation. A key role for the case manager is to be an advocate for the patient and neglecting this role could be maleficent. An unethical act of commission could be breaking confidentiality by releasing information that becomes harmful to the patient.

The Principle of Justice
Justice speaks to equity and fairness in treatment.Ethical practice today must extend beyond individuals to the institutional and societal realms. This means that, in addition to providing fairness in treatment to the patient, the institution and staff must also be treated fairly. For example, it is not fair if a patient cannot make payments and the institution has to pay for the treatments already given for the patient’s benefit.it states that equal care to every patient came with illness without considering their race, economic power, education or any factors.this is justice.

Justice may be seen as having two types: distributive and comparative. Distributive justice addresses the degree to which healthcare services are distributed equitably throughout society.Comparative justice determines how healthcare is delivered at the individual level. It looks at disparate treatment of patients on the basis of age, disability, gender, race, ethnicity, and religion.

The Principle of Veracity
Veracity (truthfulness) is not a foundational bioethical principle and is granted just a passing mention in most ethics texts. It is at its core respect for all persons by being truthful. Veracity is the opposite of the concept of paternalism, which assumes patients need to know only what their physicians choose to reveal.for example tell the patient truth about the disease and prognosis and consequence of any procedure.

The Principle of Fidelity
Fidelity is loyalty. It speaks to the special relationship developed between patients and their healthcare professionals. Each owes the other loyalty; although the greater burden is on the provider to be worthy of the patient’s trust and loyalty

For example, if a physician promises the patient they will always be there to care for them, yet leaves the organization and joins another healthcare facility, the patient may feel the physician betrayed their loyalty. The same may occur with a case manager who promises the patient and family they will be available to help them, yet leaves the employment, which may make the patient feel abandoned.