Clinical Ethics

By dr. Henky, Sp.F., M.Beth., FACLM., typed by Timmy (SGD B9 KUB ACX 1502005221)

Introduction
There are several aspects of the clinical relationship in which this trust can be either justified or
betrayed:

1. Best interests
2. Dignity and respect
3. Confidentiality

4 Quadrant Approach / 4 Topics

1. Medical indication
2. Patient preferences
3. Quality of life
4. Contextual features

Medical Indications
- What is the patients medical problem? Is the problem acute? Chronic? Critical? Reversible?
Emergent? Terminal?
- What are the goals of treatment?
- In what circumstances are medical treatment not indicated?
- What are the problems of success of various treatment options?

Patient Preferences
- Has the patient been informed of benefits and risks, understood this information, and given
consent?
- Is the patient mentally capable and legally competent, and is there evidence of incapacity?
- If mentally capable, what preferences about treatment is the patient stating?
- Who is the appropriate surrogate to make decision for the incapacitated person?
- Is the patient unwilling / unable to cooperate in medical treatment?

Quality of Life
- What are the prospects, with or without treatment, for a return to normal life, and what
physical, mental, and social deficits might the patient experience even if the treatment
succeeds?
- On what grounds can anyone judge that some quality of life would be undesirable for a
patient who cannot make or express such a judgement?
- Are there biases that might prejudice the providers evaluation of the patients quality of
life?
- What ethical issues arise concerning improving or enhancing a patients quality life?
- Do quality-of-life assessments raise any question regarding changes in treatment plans, such
as forgoing life sustaining treatment?
- What is the legal and ethical status of suicide?

1
Contextual Features
- Are there professional, interprofessional, or business interests that might create conflicts of
interest in the clinical treatment of patients?
- Are there parties other than clinicians and patients, such as family members, who have an
interest in clinical decisions?
- What are the limits imposed on patient confidentiality the legitimate interests of third
parties?
- Are there financial factors that create conflicts of interests in clinical decisions?
- Are there problems of allocation of scarce health resources that might affect clinical
decisions?
- Are there religious issues that affect clinical decisions?
- Are there legal issues that affect clinical decisions?
- Are there considerations of clinical research and education that might affect clinical
decisions?
- Are there issues of public health and safety that affect clinical decisions?
- Are there conflicts of interest with particular organizations (e.g. hospitals) that affect patient
welfare?

IDEA Framework