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 Patient: Autonomy

 Practitioner: Beneficence & Nonmaleficence

 Public Policy: Justice


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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


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.



[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.


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:



  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice


[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.


  • 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.
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  • Organization: Topics are listed alphabetically.


Tripartite Process (TAC)


Ascertain precisely what the ethical issue is

Specify and balance the four medical principles


Determine an answer


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: