Lakhasly

Abstract
An overview of ethics and clinical ethics is presented in this Review. The 4 main ethical principles, that is beneficence, no maleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between Beneficence and autonomy). A four-pronged systematic approach to ethical problem solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the Resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.
Introduction
A defining responsibility of a practicing physician is to make decisions on patient care in different settings. These decisions involve more than selecting the appropriate treatment or intervention.
Ethics is an inherent and inseparable part of clinical medicine as the physician has an ethical obligation
(1) to benefit the patient,
(ii) to avoid or minimize harm, and to
(iii) to respect the values and preferences of the patient.
Are physicians equipped to fulfill this ethical obligation and can their ethical skills be improved? A goal-oriented educational program has been shown to improve learner awareness, attitudes, knowledge, moral reasoning, and confidence
Non-maleficence
Non-maleficence refers to the physician’s obligation not to cause harm to the patient. This simple and clear principle underpins several moral rules: do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, do not deprive others of the good life. The practical application of Non-maleficence involves physicians weighing the benefits and burdens of all procedures and treatments, avoiding those that are unduly onerous, and choosing the best course of action for the patient. This is especially important and relevant when making difficult decisions about end-of-life care, such as discontinuing life-sustaining treatment, medical nutrition and hydration, as well as pain and other issues involving restraint and symptom control.
Beneficence , Non-maleficence, Professionalism • Integrated patient care model
Quality of life (QOL)
Expected QOL with and without treatment?
Deficits – physical, mental, social – may have after treatment?
Judging QOL of patient who cannot express himself/herself? Who is the judge?
Recognition of possible physician bias in judging QOL?
Rationale to forgo life-sustaining treatment(s)?



Conclusion
This review covers the basics of ethics based on moral and ethical principles using illustrative examples. The following sections define professionalism, describe its consistency with ethics, and explain the virtues required of physicians (a general term for physicians regardless of practice type). Finally, I offer a vision for an integrated model of patient care.
The essence of professionalism is a therapeutic relationship based on the physician's professional and compassionate care that meets the patient's expectations and benefits the patient. In this relationship, based on the ethical principles of benevolence and non-maleficence, the doctor satisfies the elements . Professionalism “requires putting the interests of patients ahead of those of physicians, establishing and maintaining standards of competence and integrity, and providing expert advice to society on health issues.” Ethical and humanistic values shape the former, while knowledge (e.g., by study, research, practice) and technical skills (e.g., medical and surgical procedures) form the latter. Trustworthiness leads to trust, and is a needed virtue when patients, at their most vulnerable time, place themselves in the hands of physicians. Conscientiousness is required to determine what is right by critical reflection on good versus bad, better versus good, logical versus emotional, and right versus wrong.
Thus, “caring” is in the center of the depicted integrated model, and as Peabody succinctly expressed it nearly a hundred years ago, “The secret of the care of the patient is caring for the patient”