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Evidence-Based Medicine and Resource Allocation
Published in Rui Nunes, Healthcare as a Universal Human Right, 2022
Nevertheless, in the global environment of resource allocation, EBM’s usage to restrict apparently useful clinical treatments, on the grounds of both a lack of scientific evidence and a distributive justice requirement, can be a useful tool to facilitate the access of all citizens to a reasonable level of healthcare and to promote the system’s efficiency (Taylor 1998). Moreover, from a medical ethics perspective, it may be in accordance with the long-standing tradition of beneficence in clinical practice. In fact, there is a clear distinction between resource allocation and a saving money policy. EBM implementation may even increase healthcare expenditure, but scarce resources will be then allocated more fairly to treatments of proven benefit (Figure 5.1).
The Ethics of Respect for Persons
Published in Robert M. Veatch, Laura K. Guidry-Grimes, The Basics of Bioethics, 2019
Robert M. Veatch, Laura K. Guidry-Grimes
Informed consent is a critical element of any theory that gives weight to autonomy. Hippocratic beneficence might incorporate some minimal informed consent, but only when the clinician believes informed consent will benefit the patient. For example, if a physician is about to write a prescription for diphenylhydantoin, an anti-seizure medication, she might feel obliged to say to that patient that one of the side-effects of diphenylhydantoin is that it can make one drowsy. She might warn the patient not to drive a car or operate dangerous equipment until he is sure he knows how he responds to this drug. This informing occurs, however, only because she is worried that the patient might injure himself or somebody else. The physician must provide certain information just to protect the patient.
Introduction
Published in Fritz Allhoff, Sandra L. Borden, Ethics and Error in Medicine, 2019
Beauchamp and Childress’s (2012)Principles of Biomedical Ethics, now in its seventh edition, is the most widely used ethical framework in medical ethics. The framework proposes four general principles reflecting multiple theoretical approaches: respect for autonomy, non-maleficence, beneficence, and justice. All except justice are focused primarily on the patient. Respect for autonomy concerns the patient’s freedom to choose for oneself without interference from others or under conditions that limit meaningful choice. Non-maleficence concerns providers’ obligation to refrain from intentionally injuring patients. Beneficence requires helping patients by promoting good or preventing or removing harm. Justice concerns the fair and equitable treatment of all members of a society or system based on what they are due, as well as the fair distribution of benefits and burdens within that society or system.
The Human and Humanity that Differentiate Withholding from Withdrawing Life-Sustaining Therapy: An ECMO Bridge to Nowhere
Published in The American Journal of Bioethics, 2023
Jonah Rubin, Ellen Robinson, Emily B. Rubin
The principles of beneficence and non-maleficence require doing only what is good for patients and avoiding harm. Application of these principles is necessarily value-laden and patient-specific; what one patient finds beneficial, another may not. Yet, as above, institutional guidelines cannot be tailored to account for the variability of every individual patient preference. Integrating consideration of the principles of beneficence and non-maleficence (again, not the only consideration in devising clinical protocols) might ethically rely on a best estimation of the average patient. It can reasonably be argued that most patients would prefer to avoid a bridge to nowhere, and that landing a patient on one violates the principle of non-maleficence. It is crucial to further note that most ECMO cannulation decisions must be made urgently, and given its urgency and complexity, many question whether any patient or surrogate can truly assess the risks and benefits to make an informed decision (Peetz, Sadovnikoff, and O’Connor 2015). This further supports reliance on expert opinion and input in developing institutional guidelines that are beneficent and non-maleficent. But this evaluation completely shifts once presented with a specific patient who already is on a bridge to nowhere. There is no urgent decision to be made. The specific interests of the individual patient living this reality now determine what is beneficent and non-maleficent; protocols and overarching guidelines regarding ECMO allocation are no longer relevant.
Are Alternative Neurotherapies Exempted from Using Current Scientific Evidence?
Published in AJOB Neuroscience, 2021
Research on mainstream healthcare is governed by a comprehensive ethical framework based on ethical commitments which are beneficence, nonmaleficence, respect for patient autonomy, and public accountability. Beneficence is a social commitment to public welfare by generating and providing the best information available on efficacy to healthcare practitioners, policy makers, and the public. Nonmaleficence (first, do no harm) is a commitment to protect patients and public from hazardous medical practices. Respect for patient autonomy is a commitment to allow and actively enable individuals to make voluntary choices according to their values after provision of information regarding benefits and risks that are implied in the first two commitments, accordingly, respect for patients' autonomy is possible only when individuals exercise beneficence and nonmaleficence. And lastly, public accountability which is a commitment for prudent and fair assessment of medical and healthcare resources for public welfare.
The Divided Principle of Justice: Ethical Decision-Making at Surge Capacity
Published in The American Journal of Bioethics, 2021
Connor T. A. Brenna, Sunit Das
The time-honored foundation of modern medical ethics is Beauchamp and Childress’s elegant and parsimonious variant of principlism, which balances four key moral concepts: beneficence, nonmaleficence, autonomy, and justice (Beauchamp and Childress 2001; Gillon 1994). The principle of beneficence guides action toward an expected beneficial outcome consistent with the patient’s values. Nonmaleficence requires the clinician to consider the possibility of potential harm—ranging in severity and proportioned moral import—that may result from action. Autonomy requires respect for patient choice, dependent on capacity on the part of the patient, and imparting the duty to the physician to provide sufficient information and space to the patient to make an informed, uncoerced decision. Finally, the principle of justice is defined simply as the impartial and fair adjudication between competing claims (Gillon 1985). Each ethical principle is prima facie, accepted as a universal virtue until it comes into conflict with another, at which point ethical tension arises (Gillon 1994). This conflict between principles is common and expected in medical practice: one can readily envision, for example, a situation in which an autonomous patient decides to decline beneficent treatment against medical advice.