ethical issues in emergency medicine

general principles of ethics in medicine

the right of the competent individual to determine what is or is not done to himself, and the right to choose one's own course

each person should do good for others when possible
in some circumstances, even maintaining a vegetative existence may be doing more good for the patient and family than the physician perceives

do no harm
even well-intentioned therapies have the potential to do great harm and suffering
one of the main differences between palliation and euthanasia is that in palliation, none of the care interventions are aimed at causing death but in easing pain and suffering

everyone should be treated fairly irrespective of race, religion or financial status
“distributive justice” take into account the effects upon society as a whole and introduces the notion of with-holding very expensive interventions with marginal gains if that means society as a whole will suffer more as a result of a lack of resources.

“the physician who wants to stop a treatment which the patient wishes, but which the physician views as futile, is caught in an Autonomy vs. Non-Maleficence dilemma if his/her motivation is to avoid doing harm to the patient.
The physician is in an Autonomy vs. Justice dilemma if his/her motivation is to be a responsible steward of limited health care resources.
the physician wishing to do good for the patient may be concerned that he/she is causing harm (Beneficence vs. Non-Maleficence).
Medical futility cases can also be seen as conflicts between the Autonomy of the physician (i.e., the right of the physician to refuse to provide care which conflicts with his/her conscience) and the Autonomy of the patient (i.e., the right to receive desired treatments). When the dilemma is viewed in this way, it would seem that, given the physician’s fiduciary responsibility to put the patient’s interests first, it is necessary to give primacy to the patient’s Autonomy.”¹⁾

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