1/12/2024 0 Comments BeneficenceIf the doctor is not able to manage severe or refractory symptoms, it is important to refer the patient to a qualified palliative care specialist or hospice. 1 An imperative in acting within the ethic of beneficence is to keep abreast of modern medical knowledge, which includes knowledge and understanding of palliative care. Beneficenceīeneficence provides benefit to the patient and balances the benefits against risks and costs. The doctor should be sensitive to the ‘human vulnerability, dependency and fragility’ 3 of the patient who is critically ill and to the family member acting as proxy. 7ĭecisions in the palliative care setting are often made in an environment of emotional distress. If there is no proxy, decisions should be made in the patient’s best interests, taking into account his known values and in accordance with society’s norms and values. A person may have written his wishes for future care in a Living Will 6 or Advance Directive. If a patient lacks the capacity to make decisions, a proxy decision-maker should be consulted. The Hospice Palliative Care Association Code of Ethics 5 recognises that the fundamental principle underlying all care practices is respect for the worth, dignity and human rights of every individual, and that respect for human dignity requires the recognition of patient rights, particularly the right to self-determination.Ĭapacity to make decisions depends on a person’s mental competence which may be compromised as illness progresses. Respect for autonomy underpins the concepts of informed consent, confidentiality and truth-telling about prognosis, treatment options and side-effects. The ethic of respect for autonomy contrasts with the ethic of paternalism, which sees the patient as a passive recipient of care. Respect for autonomy requires the doctor to provide full information in language and wording that promote patient understanding. This presumes a decision maker who has the required information, capacity and circumstances to make rational decisions. 3 Bioethical principles AutonomyĪutonomy – from the Greek meaning self-rule – describes the ability to make decisions for oneself based on deliberation. This article describes the four principles of autonomy, beneficence, non-maleficence, justice briefly and uses a case scenario to explore the application of these principles in a practical way, recognising the ‘importance of concrete lived experience of health care professionals and of their patients’. Shared decisions discussed in an understanding and compassionate way allow for appropriate patient care with the patient and family involvement in this care. 4 In palliative care it is always important to consider each patient individually and to develop a care plan relevant to the individual, the stage of the illness, the person’s preferences and the family’s wishes. There are concerns regarding the application of bioethical principles in that while these principles provide a guide to decision-making, they may fail to take into account the individual and family members, personal preferences and context. 2 The South African Health Professions Council has clear general ethical guidelines for the health care professions to assist this understanding. 1 In caring for patients with life-threatening illness, there are often complex decisions to be made and it is helpful to have a good understanding of the application of bioethical principles to assist decision-making. Medical decision-making is guided by the four bioethical principles of respect for autonomy, beneficence, non-maleficence and justice.
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