Written by Joanna Hughes

When the majority of medical students graduate, they swear to some form of an oath holding them to the highest code of conduct. Front and center in these professional promises?  Ethics. Whether you’re preparing for medical school interviews or you’re in the final months of your medical training, understanding these four ethical tenets of medicine can help you on your way.

1. Patient privacy

While the Healthcare Insurance Portability Accountability Act (HIPAA) has “become the face of patient privacy guidelines” over the past two decades, the concept has been around much longer than that. In fact, it dates all the way back to 400 BC and the Hippocratic Oath which includes the provision, “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about."

Today, the healthcare industry continues to deal with issues related to protecting patient information and their right to privacy. Doctors not only must adhere to all policies, procedures and laws designed to safeguard patient privacy and confidentiality, but must ensure their staff do the same. An accidental or intentional disclosure of protected health information (PHI) is a HIPAA violation which can lead to steep fines and even loss of your license.

2. Patient autonomy

Another principle of medical ethics, autonomy, asserts patients are ultimately in control of what’s good and bad for them. This can be harder than it sounds, depending on the circumstances. US News & World Report explains, “In essence, the physician provides information and it is up to the patient to make the decision. However, an important caveat to autonomy is that a physician must also make sure the patient has decision-making capacity – meaning they must be cognitively aware enough to make a sound decision.”

This can be harder than it sounds -- especially when you factor in an aging population and increasing incidences of dementia, mental illness, and other conditions which can interfere with normal decision-making.

3. Justice

Justice also makes the list of common bioethical principles. Alzheimer Europe explains, “The principle of justice could be described as the moral obligation to act on the basis of fair adjudication between competing claims. As such, it is linked to fairness, entitlement and equality.”

As with patient autonomy, while this may seem like a simple proposition, it can be much more challenging in the real world. Alzheimer Europe adds, “The right to be treated equally, and in some cases equal access to treatment, can be found in many constitutions, but in actual practice, a number of different factors may influence actual access to treatment e.g. age, place of residence, social status, ethnic background, culture, sexual preferences, disability, legal capacity, hospital budgets, insurance cover and prognosis."

In particular, patients are increasingly being turned away for economic reasons -- a phenomenon which could be viewed as being in direct contrast to this fundamental precept as medicine.

4. Reporting incompetent or unethical behaviors by colleagues

The American Medical Association’s (AMA) code of medical ethics specifies that as part of their commitment to safeguarding the welfare of patients, physicians are obligated to report incompetent or unethical conduct by others -- including their colleagues. “Reporting a colleague who is incompetent or who engages in unethical behavior is intended not only to protect patients, but also to help ensure that colleagues receive appropriate assistance from a physician health program or other service to be able to practice safely and ethically,” explains the AMA.

Unfortunately, most doctors are reluctant to report their peers -- as many as four out of five, in fact, according to Medscape. However, experts say failure to do so is akin to waiting for a piece of faulty equipment to fall on a patient before reporting it.

American Academy of Family Physicians president Michael Munger, MD, asserts of the mandate to speak up, “Very few things in this life are truly clear-cut. When we are dealing with the potential safety of patients and the impact on patient care as a whole, we must hold ourselves to the highest levels of professionalism. I know that’s kind of hard-nosed, but it’s important that we always keep this framed around patient care.”

The takeaway? While none of these issues are easy, learning to deal with them is part of practicing medicine today. As such, the ability to think critically about medical ethics, to endeavor to see both sides, and to find middle ground if possible can help you demonstrate understanding, empathy, and perspective -- all essential traits of a good physician.

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Joanna worked in higher education administration for many years at a leading research institution before becoming a full-time freelance writer. She lives in the beautiful White Mountains region of New Hampshire with her family.
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