October 12, 2011

Medical ethics (or clinical ethics) is a practical discipline employed every day in every encounter with patients and families. Clinical ethics occurs at the bedside and has to do with the day-to-day care of patients in and out of the hospital.

Usually, providing care for patients runs smoothly because the caregiver and patient share common values of working to restore the patient's health. Ethical issues are inherent in every encounter between patients and caregivers, because providing care always includes knowledge of treatments for disease processes, along with technical and moral considerations.

The patient-clinician relationship is essential for healing and includes many ethical responsibilities. Physicians take an oath "to help and do no harm" in the words of the ancient physician Hippocrates. Modern physicians have obligations to provide competent care to the patient, to preserve confidentiality and to communicate honestly and compassionately. Because the team and patient share the same goals and values, the
relationship is usually collaborative and supportive.

However, values and goals can come in conflict, resulting in an ethical question. For example, the physician's duty to provide care may be countered by the patient's refusal to participate in an indicated treatment, such as surgery. Some patients have inadequate family support for a prescribed therapy such as dialysis, which can be difficult for the patient. Patients and families may not grasp the severity of a disease, such as chronic congestive heart failure, and may not be committed to following instructions.

There are times when patients or family members believe the physician is not listening to their concerns or supporting the decisions made by or for the patient. These conflicts between caregivers and patients sometimes require a third party to sort out the issues and help bring the parties together to facilitate optimal decision making in the best interest of the patient.

The Ethics Forum at CAMC is available for this work. The Ethics Forum is composed of many different professions, such as dieticians, community members, nurses, pharmacists, physicians and social workers as well as legal assistance. This group of committed professionals specializes in assisting the caring team, patients and families to resolve differences for the best outcome for the patient.

The mission of the Ethics Forum is "to identify in collaboration with the concerned individuals the ethical dilemmas and together explore the options." This service is available to anyone at CAMC, including patients, families and employees. Patients and families should talk to a nurse about having an ethics consult if a conflict arises.

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