Ethics in Health Care
While health care can provide great benefits, it also has potential to cause great harm. Whereas drugs in appropriate doses may cure disease, drugs in inappropriate doses may harm or even kill. It might also be wrong to inflict on patients treatment which is either extremely burdensome or most unlikely to achieve any good purpose. There are also many temptations in providing health care. These include working outside one’s scope of practice, and focussing more on financial reward than on service to those in need.
Because of these dangers, almost from the beginning, health care has been guided by codes of ethics. Even now, physicians might take the Hippocratic Oath which is traced back to the father of modern medicine Hippocrates (c. 460 – c. 375 BCE). A modern version of this oath, the World Medical Association’s Declaration of Geneva includes the following commitments:
- I solemnly pledge to consecrate my life to the service of humanity;…
- The health of my patient will be my first consideration;
- I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;…
Various accounts of health care ethics are based on different ethical theories. Principle-based accounts focus on moral principles such as Beneficence and Non-maleficence, or the Principle of Double Effect. By contrast, casuistry-based accounts argue that there is greater moral certainty in specific cases than in somewhat abstract principles. Character-based accounts such as virtue ethics highlight the formation of good character in health professionals as our best guarantee that they will do what is right in their clinical practice. Or again, an ethics of care focuses on relationships, on emotion, and on the context of giving and receiving care. There are also other accounts of health care ethics based on a number of other ethical theories.
There is a poem titled ‘The Blind Men and the Elephant.’ In this poem, different blind men come into contact with different parts of an elephant, and therefore form different theories about what an elephant must be like. For example, the one who touches the elephant’s side concludes that the elephant is very like a wall. Or again, another who touches the elephant’s tail concludes that the elephant is very like a snake. Just as each of these men has understood only one part of the elephant, it seems that each of these ethical theories expresses only one of the many dimensions of ethical reality. A complete account of health care ethics must therefore draw upon many different ethical theories.
Because of the importance of ethics in health care, the education of doctors, nurses and allied health professionals includes ethical training and formation from the beginning. In the same way, specialty training must necessarily include specialised training in the specific ethical issues raised by that specialty. As well as being taught in this way, we know that ethics is also ‘caught’ by new health professionals as they recognise and adopt the ethical standards of their mentors and other senior staff. Many professional bodies and health care facilities also offer opportunities for ongoing professional development in ethics.
Good ethics helps to make good doctors, good nurses and good allied health professionals. Good ethics contributes to good patient care. These considerations reveal that ethics in health care is indeed very important.