Is there currently a lack of sustainable ethical behavior in the physicians' profession? Do doctors care enough and are their ethical behaviors adequate for the trust that people must put in them? What should doctors be doing that would make their practice more ethical and would help them to provide more real care to their patients? These questions and others will be reviewed and critiqued in this paper.
"Harm in the absence of care: Towards a medical ethics that cares"
A summary of the main points
The article that will be used as the feature article was researched and written by Elin Martinsen. It is titled, "Harm in the absence of care: Towards a medical ethics that cares." In this article the writer, who is a professor in the Faculty of Medicine at the University of Oslo in Norway, argues that in contemporary medicine and "medical ethics suffer from the lack of a theoretically sustainable concept of care" (Martinsen, 2011, 174).
Basically the main points of this article have to do with the need for more ethical practices in medicine, for more caring on the part of hospitals -- and doctors are included in that problem. Martinson explains that there needs to be a stronger, more sincere doctor-patient relationship, which will provide more human care to the patient.
Martinson concludes that while the ethics of care in the medical and healthcare fields has had a powerful influence on nurses, the same cannot be said for physicians. In fact in the literature regarding nursing ethics the concept of "care" can be seen often and is a prominent feature in nursing materials. But in the medical literature more generally referencing doctors and the healthcare industry, the ethical concept of care is "…still situated at the margins."
Other main points by Martinson
A 49-year-old man named Martin has been experiencing powerful headaches so he calls his doctor and the doctor refers him to the hospital. He lies there a long time before a doctor arrives late at night and tells him that the MRI revealed a "highly malignant brain tumor" in his head (Martinson, 175). The doctor tells him he might live for a few months but there's no cure for his tumor. He asks Martin if Martin has questions and then "…promptly leaves, leaving the patient alone" (Martinson, 175). The doctor left Martin feeling "numb," and Martin said being left alone after being told he would die soon caused "…chaos in my body" (Martinson, 175).
Was that an ethical, caring thing for the doctor to do? It is easy to answer that question because it was uncaring and so it was also unethical. This, and other examples by Martinson show that doctors are too detached from the feelings of their patients. One of the "core principles" in medical ethics is "autonomy," which refers to the rights of patients -- including the right to "determine what happens to their own body, the right to informed consent, and the right to participate in the medical decision-making process" in any medical or doctor setting, Martinson asserts (180).
Care, according to Martinson's article, involves sympathy, compassion, and altruistic virtues; care is an important part of the ethical behaviors of healthcare professionals, and in order to truly provide care for patients, doctors need to practice "good deeds" and take "positive steps to help others," which Martinson believes is not always the case today (180).
Integration of ethics teaching within GP training
An article by Katy Daniels points out that there is a need for more ethics to be taught to future doctors. Ethical dilemmas need to be resolved, Daniels suggests, and so the Royal College of General Practice had put in place a new curriculum for training general practitioner doctors. This is a new approach, Daniels explains, because it benefits future doctors by "…having ethics teaching integrated with clinical work" (Daniels, 2012, 75). What are the best approaches to teaching ethics and caring for future doctors? Daniels mentions several points as to the teaching of ethics in medical school: a) "induction" (this process makes trainees aware of how important ethics is to a doctor); b) "integration" (ethics as a subject is integrated into every aspect of a doctor's training); c) "inclusion" (since ethics is not as "stand-alone" subject, isolated from other medical issues, ethics must be taught to all staff and doctors should be role models when it comes to ethics); and d) "individual application" (all doctor trainees will benefit from having the chance to discuss and reflect on "ethical problems they have encountered with their peers") (Daniels, 75).
Ethics: Should doctors prescribe medications for patients in all cases?
Timothy Hotze and colleagues write in The American Journal of Bioethics that some doctors are willing to prescribe medications for patients to "…enhance athletic, aesthetic, and cognitive performance, rather than to treat disease" (Hotze, et al., 2011, 3). Certainly this kind of prescribing by doctors has ethical questions that go along with it, so the authors surveyed 1,500 physicians (from the files of the American Medical Association). Of those 1,500 surveys, 633 were filled out and returned.
The doctors were surveyed as to how often patients asked them for medicines or services that the doctors considered "…to be for enhancement" -- and the doctors were asked how often the doctors actually provided "…or would consider providing such medicines and services" (Hotze, 4). Incidentally, "enhancements" refers to things like "mood enhancements" (like valium) and drugs that give athletes a physical or mental boost (but not steroids, which are illegal in any event).
The results of this survey showed some very interesting responses. Most physicians report that they have received requests for enhancements and one-third responded that enhancements are "too risky" (Hotze, 8). About 56% of the respondents argued that "most medical interventions could qualify as 'enhancements'"; and 41% said medical enhancements tend to reduce human suffering so they are justified. A majority of doctors (57%) reported that society should try to "…prevent individual economic advantages from turning into biological advantages"; that is, wealthy people can afford certain medications that enhance their lives but people of lesser means cannot afford those medications. In fact, 55% of the respondents agreed that "…if a particular medical enhancement is allowed (legal), everyone should have equal access to it" (Hotze, 8).
Pills that help students think more clearly, or that help children grow taller, should be "allowed" but "not promoted," according to most doctors completing the survey (Hotze, 8). Moreover, 20% of doctors would prescribe medicines to suppress appetites "without reservation" but 58% would do so "with reservations." The doctors' responses to this survey show a wide disparity in ethical approaches to people's needs vs. their desire for enhancements.
Is "concierge medicine" an ethical way for doctors to serve patients?
Richard Thompson, an author and former vice president of the Illinois Hospital Association, explains that "concierge medicine" is a strategy in which families pay a certain amount of money in a "retainer" (like lawyers get from clients) in order to be services by a doctor or his office. What is the impact on professional ethics? Thompson, himself a doctor, writes that putting the patient first is part of the social responsibility of a physician -- and supposedly concierge medicine does that because the doctor has few patients and can spend more time with each patient under this system.
But is it ethical for the doctor to be concerned about making the maximum amount of money with a small practice and fewer patients; and only those patients that can afford to pay a retaining fee like lawyers charge? Thompson wonders, "When did doctors come to consider personal attention and quality care an exceptional service requiring a special fee, as opposed to being a definition of the professional ethic?" He also wonders if this is the proper ethical image that doctors want to reflect and project.
One of the problems with this approach (concierge medicine) is that when doctors lose a perspective -- when the "balance between entrepreneurial initiative and social responsibility gets too heavily weighted in favor of the doctor" -- it could happen that doctors won't be considered healthcare professions at all. They might end up being seen as business people, and then the ethical issues will be compounded.
Ethics, law and paediatric medicine
An article in the Journal of Paediatrics and Child Health covers the issue of children, doctors, and ethics. Clearly when a child is very young the parents provide consent for whatever procedures doctors need to (or believe they need to) conduct. But when a mature teenager need medical treatment, even though those individuals are not yet formally known as adults, the doctor still has an ethical responsibility to protect their patients' confidential information (Waller, 2011). Herein is the potential ethical issue; if doctors see what needs to be done for the child, no matter the age of the child, and the parents don't see it the same way, is the doctor ethically on solid ground by going…