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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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B. Introduction
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As a member of the medical profession, the health and well-being of my patient will be my first consideration.
~ Declaration of Geneva
Enigmatic Illness
A Medical Murder Mystery
Dr. Jonas Salk, an experienced medical practitioner, was presented with a perplexing case at St. Agnes Hospital. The patient, Mr. Samuel Johnson, had been exhibiting a series of symptoms that left even the most seasoned doctors baffled. As Dr. Salk examined Mr. Johnson, she realized that something about this case was different from any other she had encountered.
In her pursuit to diagnose and treat Mr. Johnson’s condition, Dr. Salk found herself immersed in a complex web of ethical dilemmas, forcing her to confront the four principles of medical ethics: autonomy, beneficence, nonmaleficence, and justice. The enigmatic nature of Mr. Johnson’s illness presented numerous challenges to the usual patient-practitioner relationship and demanded a deeper understanding of effective communication and empathy.
As Dr. Salk delved deeper into the medical history and life of Mr. Johnson, she uncovered a dark secret that threatened not only her patient’s life but also the integrity of the medical profession. It appeared that someone, potentially within the medical community, had intentionally exposed Mr. Johnson to a rare and deadly toxin. The revelation raised several ethical questions, such as whether the perpetrator should be reported and how this would impact the patient’s autonomy and the public’s trust in the medical profession.
Dr. Salk employed the tripartite process of thinking, assessing, and concluding to navigate the ethical dilemmas she faced. She first identified the ethical issues at hand, such as the potential harm to Mr. Johnson and the implications of the toxin exposure on the wider community. Then, she assessed the four principles of medical ethics, carefully balancing them to determine the best course of action.
In the end, Dr. Salk concluded that she must prioritize her patient’s best interests and well-being, as outlined in the Declaration of Geneva. She sought to involve Mr. Johnson in the decision-making process while simultaneously taking steps to ensure the safety of others who might be at risk. Dr. Salk reported the situation to the appropriate authorities, demonstrating her commitment to justice and the medical profession’s behavioral expectations.
Throughout the investigation, Dr. Salk maintained open and empathetic communication with Mr. Johnson, educating him about his condition and treatment options. Despite the challenges and moral complexities of the case, she managed to develop a strong patient-practitioner relationship that ultimately contributed to the successful resolution of the case.
The Enigmatic Illness served as a poignant reminder of the importance of medical ethics, effective communication, and empathy in healthcare. Dr. Salk’s adherence to the tripartite process and the four principles of medical ethics allowed her to navigate this intricate murder mystery, ultimately prioritizing her patient’s best interests and preserving the integrity of the medical profession.
Abstract
The guidebook ETHICS For MEDICINE covers ethical and moral issues facing medical practitioners and provides the reader with the steps to identify the best pathway for maximizing the patient’s best interest. It contains 60 topics for medical education and ongoing reference for clinical practice and academic writings. Each topic is designed to address specific high-yield content for medical licensing exams and provides a framework for the medical profession’s behavioral expectations. The approach used in this book is the tripartite process - Think, Assess, and Conclude - where the practitioner considers the ethical issue, specifies and balances the four principles of medical ethics (autonomy, beneficence, nonmaleficence, and justice), and determines an answer that is consistent with the medical standards of care. This approach also emphasizes the importance of effective communication and empathy in establishing a patient-practitioner relationship that maximizes the patient’s best interests.
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Introduction
[B:1] Medical ethics has become a high priority within medical education and the medical profession as the field has evolved from a paternalistic hierarchy—the doctor knows best—to a shared decision-making process between the patient and the practitioner. The focus is now:
the maximization of the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities within the framework of the medical standards of care.
[B:2] This book presents the methodology and the ethical principles necessary for evaluating sixty moral topics that practitioners frequently encounter in the medical profession and the healing arts.
[B:3] Every topic covered focuses on maximizing the patient’s best interests from three perspectives: the patient, the medical practitioner, and public policy. The goal is to gain the knowledge, tools, and skills to develop new patient insights, professional discernments, and public policy understandings necessary for maximizing the patient’s best interests.
Tripartite Process - TAC
[B:4] When assessing an ethical issue, the medical practitioner should methodically think, assess, and conclude.
Think: Ascertain precisely what the ethical issue is.
Assess: Specify and balance the four principles of medical ethics.
Conclude: Determine an answer appropriate to and consistent with the medical standards of care. The medical standards of care is defined by clinical practice guidelines, relevant medical associations, and evidence-based science and practice.
[B:5]
1. Think
[B:6] Ascertain precisely what the ethical issue is. Medical practitioners are trained masters of the art of inquiry. The medical practitioner provides an objective evidence-based diagnosis and prognosis of the patient’s ailment by carefully establishing the signs and symptoms, the cause, and the treatment of the working diagnosis, all within the subjective ethical framework of the patient-practitioner relationship and the objective medical standards of care.
2. Assess
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
- 1. Patient Autonomy (informed consent)
- 2. Practitioner Beneficence (do good), Nonmaleficence (do no harm)
- 3. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance encountered.
3. Conclude
[B:8] After the assessment, a conclusion must be logically determined. However, because specific state laws vary so much from state to state and date to date, this text will primarily focus on the national medical standards of care. Medical standards of care is peer reviewed evidence-based medicine that is recognized by the healthcare community and established by the medical profession’s “opinions” and “councils” of definitive behavioral expectations.
[B:9] If the medical practitioner has:
- a) thought through precisely what the ethical issue is,
- b) assessed the ethical issue by specifying and balancing the four principles of ethics for medicine,
- c) then the medical practitioner will be able to conclude with an answer that is in accordance with the medical standards of care.
[B:10] This approach of think, assess, and conclude is also applicable for demonstrating rational and logical thinking, effective communication skills, and the ability to project empathetic social skills necessary for establishing a patient-practitioner relationship that will maximize the patient’s best interests. Without effective communication, it is impossible to properly educate the patient regarding their diagnosis, prognosis, treatment options, benefits and risks of the options presented, and to answer patient’s questions satisfactorily.
[B:11] The structure used for each topic will be as follows:
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
[B:12] After each topic, there will be:
- 1. Topic Review Questions: A series of true/false and multiple choice questions.
- 2. Clinical Vignettes: Five NBME-style multiple choice clinical vignettes
- 3. Topic Reflective Vignettes: Two thought provoking vignettes.
**
Paragraph Numbering: Each paragraph of the text has a unique identifying number. Since the electronic version of the text has no pagination, the paragraph numbering system provides for location and a citation method.
NAVIGATION:
- • Table of Contents: Select topic title or page number. To navigate back to Table of Contents, select any top-header or bottom-footer.
- • Review Questions: Select the answer option and an answer-field will pop-up indicating whether or not the selection was correct or incorrect along with the paragraph text explaining the answer.
- • Case Study Write-Up: Select the case study button-link. To navigate back to the topic location, select the Return button-link.
- • Organization: Topics are listed alphabetically.
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Tripartite Process (TAC)
THINK
Ascertain precisely what the ethical issue is
Specify and balance the four medical principles
ASSESS
Determine an answer
CONCLUDE
B. Review Questions
1. The primary end or purpose of medical ethics is to:
2. The tripartite process refers to:
3. The Four Principles of medical ethics are:
4. Specification:
5. Balancing:
6. Since ethics is a subjective experience, it is by definition relative. Therefore, it is not possible for the medical profession to establish definitive behavioral expectations.
7. Effective communication skills are central to the art of medicine because the medical practitioner must answer the patient’s questions and educate the patient about:
CORRECT! 🙂
[B:1] Medical Ethics has become a high priority within medical education and the medical profession itself, as the field has evolved from a paternalistic hierarchy—the doctor knows best—to one of more shared responsibility for decisions between patient and practitioner. The focus is to be:
the maximization of the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities within the framework of the medical standards of care.
Wrong 😕
[B:1] Medical Ethics has become a high priority within medical education and the medical profession itself, as the field has evolved from a paternalistic hierarchy—the doctor knows best—to one of more shared responsibility for decisions between patient and practitioner. The focus is to be:
the maximization of the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities within the framework of the medical standards of care.
CORRECT! 🙂
[B:4] When assessing an ethical issue, the practitioner should take the time to think, assess, and conclude.
Think: Ascertain precisely what the ethical issue is.
Assess: Specify and balance the four principles of medical ethics.
Conclude: Determine an answer.
Wrong 😕
[B:4] When assessing an ethical issue, the practitioner should take the time to think, assess, and conclude.
Think: Ascertain precisely what the ethical issue is.
Assess: Specify and balance the four principles of medical ethics.
Conclude: Determine an answer.
CORRECT! 🙂
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
1. Patient Autonomy (informed consent),
2. Practitioner Beneficence (do good),
3. Practitioner Nonmaleficence (do no harm), and
4. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance.
Wrong 😕
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
1. Patient Autonomy (informed consent),
2. Practitioner Beneficence (do good),
3. Practitioner Nonmaleficence (do no harm), and
4. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance.
CORRECT! 🙂
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
1. Patient Autonomy (informed consent),
2. Practitioner Beneficence (do good),
3. Practitioner Nonmaleficence (do no harm), and
4. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance.
Wrong 😕
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
1. Patient Autonomy (informed consent),
2. Practitioner Beneficence (do good),
3. Practitioner Nonmaleficence (do no harm), and
4. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance.
CORRECT! 🙂
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
1. Patient Autonomy (informed consent),
2. Practitioner Beneficence (do good),
3. Practitioner Nonmaleficence (do no harm), and
4. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance.
Wrong 😕
[B:7] Morally assess the query by specifying and balancing the four principles of medical ethics:
1. Patient Autonomy (informed consent),
2. Practitioner Beneficence (do good),
3. Practitioner Nonmaleficence (do no harm), and
4. Public Policy Justice (be fair)
a) Specification: Determine how each of the four principles applies to a particular circumstance.
b) Balancing: Determine the relative weight of each specified principle for the particular circumstance.
CORRECT! 🙂
[B:8] After the assessment, a conclusion must be logically determined. However, because specific state laws vary so much from state to state and from date to date, this text will primarily focus on the national standard of medical practice. Medical practice is peered reviewed evidence-based medicine that is recognized by the healthcare community and established by the medical profession’s “opinions” and “councils” of definitive behavioral expectations.
Wrong 😕
[B:7] After the assessment, a conclusion must be logically determined. However, because specific state laws vary so much from state to state and from date to date, this text will primarily focus on the national standard of medical practice. Medical practice is peered reviewed evidence-based medicine that is recognized by the healthcare community and established by the medical profession’s “opinions” and “councils” of definitive behavioral expectations.
CORRECT! 🙂
[B:10] This approach of think, assess, and conclude is also applicable for demonstrating rational and logical thinking, effective communication skills, and the ability to project empathetic social skills necessary for establishing a patient-practitioner relationship that will maximize the patient’s best interests. Without effective communication, it is impossible to properly educate the patient regarding their diagnosis, prognosis, treatment options, benefits and risks, and to answer patient’s questions.
Wrong 😕
[B:10] This approach of think, assess, and conclude is also applicable for demonstrating rational and logical thinking, effective communication skills, and the ability to project empathetic social skills necessary for establishing a patient-practitioner relationship that will maximize the patient’s best interests. Without effective communication, it is impossible to properly educate the patient regarding their diagnosis, prognosis, treatment options, benefits and risks, and to answer patient’s questions.
B. Clinical Vignettes
1. Mr. Henry Jones, a 57-year-old factory worker comes to the clinic with complaints of chest pain and shortness of breath. The patient has a history of smoking and high blood pressure. After a thorough examination and testing, the practitioner determines that the patient has a blocked artery and needs immediate surgery. The patient is anxious and concerned about the outcome of the surgery, and expresses a strong desire to be informed about all options, including the risks and benefits of the procedure. The primary end or purpose of the book ETHICS For MEDICINE is to:
2. A practitioner is faced with an ethical dilemma regarding the treatment of a patient. The provider must carefully consider the patient's autonomy, professional obligations of nonmaleficence and benevolence, and public policy of justice. What does the tripartite process refer to in the book ETHICS For MEDICINE?
3. Ms. Wendy Rodriguez, a 27-year-old software engineer has come to see a practitioner for treatment. The practitioner must make a decision about the best course of action for the patient, taking into account the patient's autonomy, the practitioner's obligation to do good and avoid harm, and considerations of fairness and justice in public policy. In the book ETHICS For MEDICINE, The Four Principles of Bioethics are which of the following?
4. Mr. Alexander Martinez, a 30-year-old electrician presents with a complex medical issue that raises ethical concerns. In order to address this issue, you are asked to apply the four principles of biomedical ethics to the particular circumstance. The four principles are autonomy (informed consent), beneficence (do good), nonmaleficence (do no harm), and justice (be fair). What does "Specification" mean in the context of biomedical ethics?
5. A healthcare professional is faced with a difficult decision while treating a patient. They must consider the principles of autonomy, beneficence, nonmaleficence, and justice when determining the best course of action. In the book ETHICS For MEDICINE “Balancing” means:
Wrong 😕
Explanation: In this scenario, the patient's best interests should be the focus of the medical team. The book "ETHICS for MEDICINE" aims to promote the patient's best interests as its primary objective. This reflects the shift in medical ethics towards a patient-centered approach, where the patient's goals, values, and priorities are given priority within the framework of medical standards of care [B:2]. By promoting the patient's best interests, the book contributes to the development of a more empathetic, virtuous, and selfless medical community, where the patient's informed consent and autonomy are respected [B:5].
CORRECT! 🙂
Explanation: In this scenario, the patient's best interests should be the focus of the medical team. The book "ETHICS for MEDICINE" aims to promote the patient's best interests as its primary objective. This reflects the shift in medical ethics towards a patient-centered approach, where the patient's goals, values, and priorities are given priority within the framework of medical standards of care [B:2]. By promoting the patient's best interests, the book contributes to the development of a more empathetic, virtuous, and selfless medical community, where the patient's informed consent and autonomy are respected [B:5].
Wrong 😕
Explanation: According to the book "Ethics for Medicine," the practitioner should methodically think, assess, and conclude when assessing an ethical issue [B:4]. The provider must carefully consider the patient's autonomy (informed consent), the professional obligations of nonmaleficence (do no harm) and benevolence (do good), and the public policy of justice (be fair) [B:7]. The provider first thinks about the ethical issues at hand and precisely determines what they are [B:4] [B:6]. They then assess the situation by specifying and balancing the four principles of biomedical ethics [B:4] [B:7]. Finally, they conclude by determining an answer that is appropriate and consistent with the medical standards of care, which are defined by clinical practice guidelines, relevant medical associations, and evidence-based science and practice [B:4] [B:8]. The tripartite process helps the provider make informed and ethical decisions regarding the treatment of their patients [B:1].
CORRECT! 🙂
Explanation: According to the book "Ethics for Medicine," the practitioner should methodically think, assess, and conclude when assessing an ethical issue [B:4]. The provider must carefully consider the patient's autonomy (informed consent), the professional obligations of nonmaleficence (do no harm) and benevolence (do good), and the public policy of justice (be fair) [B:7]. The provider first thinks about the ethical issues at hand and precisely determines what they are [B:4] [B:6]. They then assess the situation by specifying and balancing the four principles of biomedical ethics [B:4] [B:7]. Finally, they conclude by determining an answer that is appropriate and consistent with the medical standards of care, which are defined by clinical practice guidelines, relevant medical associations, and evidence-based science and practice [B:4] [B:8]. The tripartite process helps the provider make informed and ethical decisions regarding the treatment of their patients [B:1].
CORRECT! 🙂
Explanation: The Four Principles of Bioethics, as described in ETHICS For MEDICINE, are Autonomy, Beneficence, Nonmaleficence, and Justice [B:1]. These principles provide a framework for making ethical decisions in medical practice [B:1]. Autonomy refers to the patient's right to make informed decisions about their own medical care [B:1]. Beneficence and Nonmaleficence require the practitioner to act in the best interests of the patient and avoid causing harm [B:1]. Justice involves considerations of fairness and equity in public policy and distribution of resources [B:1].
Wrong 😕
Explanation: The Four Principles of Bioethics, as described in ETHICS For MEDICINE, are Autonomy, Beneficence, Nonmaleficence, and Justice [B:1]. These principles provide a framework for making ethical decisions in medical practice [B:1]. Autonomy refers to the patient's right to make informed decisions about their own medical care [B:1]. Beneficence and Nonmaleficence require the practitioner to act in the best interests of the patient and avoid causing harm [B:1]. Justice involves considerations of fairness and equity in public policy and distribution of resources [B:1].
Wrong 😕
Explanation: The term "Specification" in the context of biomedical ethics refers to the process of determining how each of the four principles of biomedical ethics applies to a particular circumstance [B:7]. This involves evaluating and applying the principles of autonomy (informed consent) [B:7], beneficence (do good) [B:7], nonmaleficence (do no harm) [B:7], and justice (be fair) [B:7] to the specific ethical dilemma presented in the clinical scenario.
CORRECT! 🙂
Explanation: The term "Specification" in the context of biomedical ethics refers to the process of determining how each of the four principles of biomedical ethics applies to a particular circumstance [B:7]. This involves evaluating and applying the principles of autonomy (informed consent) [B:7], beneficence (do good) [B:7], nonmaleficence (do no harm) [B:7], and justice (be fair) [B:7] to the specific ethical dilemma presented in the clinical scenario.
Wrong 😕
Explanation: Balancing in the context of biomedical ethics refers to the process of weighing the relative importance of each of the four principles in a given situation [B:7]. It is essential for healthcare professionals to consider all relevant principles and determine their relative weight in order to make informed and ethical decisions [B:7]. By doing so, they can ensure that the course of action they choose aligns with their ethical obligations and promotes the best interests of the patient [B:1].
CORRECT! 🙂
Explanation: Balancing in the context of biomedical ethics refers to the process of weighing the relative importance of each of the four principles in a given situation [B:7]. It is essential for healthcare professionals to consider all relevant principles and determine their relative weight in order to make informed and ethical decisions [B:7]. By doing so, they can ensure that the course of action they choose aligns with their ethical obligations and promotes the best interests of the patient [B:1].
