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INTRODUCTION

Physicians face novel ethical dilemmas that can be perplexing and emotionally draining. For example, telemedicine, artificial intelligence, handheld personal devices, and learning health care systems all hold the promise of more coordinated and comprehensive care, but also raise concerns about confidentiality, the doctor–patient relationship, and responsibility. This chapter presents approaches and principles that physicians can use to address important vexing ethical issues they encounter in their work. Physicians make ethical judgments about clinical situations every day. They should prepare for lifelong learning about ethical issues so they can respond appropriately. Traditional professional codes and ethical principles provide instructive guidance for physicians but need to be interpreted and applied to each situation. When facing or struggling with a challenging ethical issue, physicians may need to reevaluate their basic convictions, tolerate uncertainty, and maintain their integrity while respecting the opinions of others. Physicians should articulate their concerns and reasoning, discuss and listen to the views of others involved in the case, and utilize available resources, including other health care team members, palliative care, social work, and spiritual care. Moreover, ethics consultation services or a hospital ethics committee can help to clarify issues and identify strategies for resolution, including improving communication and dealing with strong or conflicting emotions. Through these efforts, physicians can gain deeper insight into the ethical issues they face and usually reach mutually acceptable resolutions to complex problems.

APPROACHES TO ETHICAL PROBLEMS

Several approaches are useful for resolving ethical issues, including approaches based on ethical principles, virtue ethics, professional oaths, and personal values. These various sources of guidance may seem to conflict in a particular case, leaving the physician in a quandary. In a diverse society, different individuals may turn to different sources of moral guidance. In addition, general moral precepts often need to be interpreted and applied to a particular clinical situation.

ETHICAL PRINCIPLES

Ethical principles can serve as general guidelines to help physicians determine the right thing to do.

Respecting Patients

Physicians should always treat patients with respect, which entails understanding patients’ goals, providing information, communicating effectively, obtaining informed and voluntary consent, respecting informed refusals, and protecting confidentiality. Different clinical goals and approaches are often feasible, and interventions can result in both benefit and harm. Individuals differ in how they value health and medical care and how they weigh the benefits and risks of medical interventions. Generally, physicians should respect patients’ values and informed choices. Treating patients with respect is especially important when patients are responding to experiences of, or fears about, disrespect and discrimination.

GOALS AND TREATMENT DECISIONS

Physicians should provide relevant and accurate information for patients about diagnoses, current clinical circumstances, expected future course, prognosis, treatment options, and uncertainties, and discuss patients’ goals of care. Physicians may be tempted to withhold a serious diagnosis, ...

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