Western medicine was founded on our Judeo-Christian and Greco-Roman heritage, where the sanctity of life and the dignity of the human person are paramount for decision-making in patient care. Patients place their trust in physicians and nurses to care for them in a compassionate and ethical manner, and we have a moral obligation to properly fulfill that role. Although the majority of Americans remain Christian, our multicultural and secular environment has made it more difficult to maintain a universal sense of objective morality. Unanimous agreement on moral issues between physicians and patients is not always possible in our pluralistic society. It is essential to include their religious beliefs when one obtains the social history in order to relate to the patient.
Medical ethics encompasses beneficence, Non-maleficence, autonomy, and justice as they relate to conflicts such as euthanasia, patient confidentiality, informed consent, and conflicts of interest in healthcare. In addition, medical ethics and culture are interconnected as different cultures implement ethical values differently, sometimes placing more emphasis on family values and downplaying the importance of autonomy. This leads to an increasing need for culturally sensitive physicians and ethical committees in hospitals and other healthcare settings.
1. Autonomy
Requires that the patient have autonomy of thought, intention, and action when making decisions regarding health care procedures. Therefore, the decision-making process must be free of coercion or coaxing. In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success. Because ARTs are highly technical and may involve high emotions, it is difficult to expect patients to be operating under fully-informed consent.
2. Justice
The idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Requires that procedures uphold the spirit of existing laws and are fair to all players involved. The health care provider must consider four main areas when evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation. Reproductive technologies create ethical dilemmas because treatment is not equally available to all people.
3. Beneficence
Requires that the procedure be provided with the intent of doing good for the patient involved. Demands that health care providers develop and maintain skills and knowledge, continually update training, consider individual circumstances of all patients, and strive for net benefit.
4. Non-maleficence
Requires that a procedure does not harm the patient involved or others in society. Infertility specialists operate under the assumption that they are doing no harm or at least minimizing harm by pursuing the greater good. However, because assistive reproductive technologies have limited success rates uncertain overall outcomes, the emotional state of the patient may be impacted negatively. In some cases, it is difficult for doctors to successfully apply the do no harm principle.
Jesus Christ gave us the Beatitudes as recorded in the New Testament of the Bible. The Beatitudes are presented in a positive sense, virtues in life which will ultimately lead to reward in Heaven. He taught us the Golden Rule in the Sermon on the Mount: “Do unto others as you would have them do unto you” (Matthew 7:12). He taught us the two greatest commandments are to love God and to love your neighbor as yourself (Matthew 22:36-40, Mark 12:28-31, Luke 10:25-28). St. Paul taught us to respect the human body, for our bodies are temples of the Holy Spirit (I Corinthians 6:19); he incorporated the spirit, soul, and body all in one sentence (I Thessalonians 5:23).
Thus the tradition of Western Christian civilization and American medicine is founded upon the Biblical ethic and the traditions of our Greco-Roman heritage.
God created the world and we are made in his “image and likeness” (Genesis 1:26-28). Jesus Christ treasured every human being, for he said, “As you did it to the least one of these my brethren, you did it to me” (Matthew 25:40). Thus man has an innate dignity because we are creatures of God. The natural response to God’s gift of love and life is gratitude and the obedience of faith to our Father (Romans 1:5)! Moral conduct therefore shows itself to be consent to God our Creator – it is the human response to the creative love of God.
But our first parents, Adam and Eve, led by the Temptor, were disobedient, and moral disarray entered the world. The creatures put themselves before God, “worshiping and serving the creature rather than the Creator” (Romans 1:25).
Following the fall of Adam and Eve, God sent his only Son, “that whoever believes in Him may have eternal life” (John 3:16). And Jesus was obedient to His Father and served as our model of moral behavior. Moral behavior is living in harmony with the will of God!
It is for us to “live in Christ.” Because of our weak nature, it is easy for us to fall (Romans 6-8; Galatians 5). But God sent us grace through the Holy Spirit, to help us be obedient to the Father, to “free us from the law of sin and death” (Romans 8:2). Grace perfects nature, to help us live the Way (Acts 9:2, 19:23, 22:4) of Christ!
Grace is God’s free gift of himself, and virtue is man’s free response to God. The practice of virtue is essential to Christian morality, the profession of Medicine, and a stable society! There are seven virtues, the Theological virtues of faith, hope, and charity, and the Cardinal or moral virtues of prudence, justice, fortitude, and temperance. The virtues of Faith, Hope and Charity unite us to God, and are also essential in patient care, for it is important that our care be based on God’s healing power, that we instill hope in our patients and are compassionate with them. The Cardinal or moral virtues guide us in our conduct and relationships during life, especially in the art of medicine. Faith is a personal commitment to God who reveals His saving truths and to those truths which he reveals. Hope is the desire for God and the trust we will receive the graces to be with Him in heaven. Charity leads us to love God above all things and our neighbor as ourselves. Prudence is a moral virtue which helps us make the right choice in every instance to allow us to properly treat our patients and accomplish our ultimate goal of union with God. Justice leads us to respect the rights of others and to give them their due. Fortitude gives us the courage to carry out what is right, and be a true patient advocate, even in the face of difficulty! Temperance gives us self-control over our desires and appetites.in. The pediatrician Melvin Morse, in his studies of children who described near-death experiences, presented the concept that the soul is the source of energy to the body.
Resources
Basic Principles in Medical Ethics – CRASH! Medical Review Series. Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
