**4. Importance of medical ethics**

Medical ethics is important both in medical practice which involves the patient doctor relationship and in medical research. Some of the roles of medical ethics are:


## **5. Ethical dilemma**

Controversies and conflict sometimes occur in the practice of medicine especially in the decision making process. Sometimes, these conflict occurs in the shared decision making as conflicts arise when the doctors and patient decisions contravenes medical ethical principles. Generally everyday there are ethical dilemma occurs daily in the practice of medicine [14, 25, 26]. Ethical dilemma has been described by the World Health Organization as a dilemma between different values which are seen as necessary particularly in cases and circumstances in conflict with each other [10]. It occurs when all the possible remedy for a clinical care will lead to moral violation [8, 23]. Sometimes, there are no answers to ethical dilemmas [27]. These ethical dilemmas arise when there are options for the decisions which may be compelling reasons and actions [19]. Ethical dilemma consists of a type of ethical problem. From several researchers, there is a relationship between ethical dilemma and ethical principles [28]. No ethical principle can explain adequately ethical dilemma [2]. There is a connection between facts, values and morals conflict, some of the problems associated with ethical dilemma have been there for centuries with medical ethics [29]. Ethical dilemma is a product of conflict arising from ethical principles and options [30, 31]. When ethical dilemma occurs, it can be resolved using individualistic approach as there are no general principles in tackling it [17, 23]. Ethical dilemma is not limited to medical practice only as it also occurs in medical research [14]. The establishment of a comprehensive ethical framework and legal framework will guide medical health care workers in resolving ethical dilemma.

Ethical dilemma can be found in telemedicine, artificial intelligence, COVID-19 testing, management of near end of life care, medical error, priority testing, biotechnology, medical ethics education, e-health and bioethics [10]. Some of the factors and barriers to ethical dilemmas are connected to medical facts, individual characteristics and unclassified factors [31].

**Medical Factors**: Some of the medical factors associated with ethical dilemmas are the patient's history, diagnostic results, risks, complications and previous intervention associated with the illness the patient is suffering from.

#### **6. Individual characteristics**

There are some characteristics that are peculiar to everyone that can lead to ethical dilemma. These factors affect the decision process of the patient. These include values, culture, religion, relationships and previous experiences [31]. The belief system affects medical care.

#### **7. Unclassified factors**

There are some factors not associated with individual characteristics and medical affects that affect decision making process. These include the logistics facility,

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*Medical Ethics*

*DOI: http://dx.doi.org/10.5772/intechopen.95382*

**8. Some ethical dilemmas**

approaches [3].

security should be maintained always [32].

discussed below:

competing interests and Interprofessional perspectives [31]. In some countries, there have been Interprofessional rivalry between the different categories of health care workers and the clients and patients are the ones who suffer when such occur.

Healthcare professionals regularly encounter ethical dilemmas while carrying out their duties [3, 17, 27]. Some situations in which ethical dilemma can occur are

1.**Near End of Life**: End of life is a topic and phenomenon that has been debated for several decades. There is the ethical dilemma if end of life care should be provided or should such patients be abandoned? Is end of life care a waste of resources? Especially in low resource counties where health insurance is not available. Near end of life care is expensive as it may involve artificial nutrition hydration, telling the patient's care givers the truth and disagreement that may arise in the course of management. Such disagreements may include continuation of artificial ventilation or administration of oxygen, care in the intensive care unit. Moral distress sometimes is experienced by the physician, patient and their caregivers when there are unexpected clinical developments as death

2.**Telemedicine:** Telemedicine means "healing from a distance" and it is very beneficial [32]. Telemedicine is becoming popular due to the need for social and physical distancing especially in this time of the COVID-19 pandemic. During telemedicine proper history taking may not be gotten and a comprehensive physical examination may not be done. Physical examination is important in every medical consultant. Ethical dilemma occurs in telemedicine due to the conflict in productivity and patient confidentiality which cannot be obtained. Privacy cannot be attained in the patient-doctor relationship while using telemedicine [30]. This is worst if artificial intelligence is also used. During consultation using telemedicine, it must be done in a secure and safe way so that medical electronic information is not leaked out. Therefore passwords

3.**Coronavirus-2019 (COVID-19) Testing**: The ethical considerations in the management of epidemics are different [16]. This is not different for the Covid-19 pandemic as several ethical principles are affected by the pandemic. This includes autonomy, truthfulness, confidentiality and justice. In the Covid-19 pandemic, testing is done without consent of the patient. This is also to help in the control and to protect others. Also the ethical principle of autonomy is not respected during contact racing [33]. Confidentiality is not maintained in the Covid-19 testing in order to protect the public. This is why it is required before air travel especially international travel and also admission and entry into certain public places such as schools and camps. There is the ethical dilemma in the allocation of the scare resources and medical supplies, therefore question to be answered are who need what? Hence the ethical principle of justice has to be practiced. The physician decides which patient may likely die or lives, which patient should be connected to the ventilator, which is in short supply worldwide. Allocation of these scares medical resources must be done fairly and with justice [16, 34]. This has created a high ethical dilemma which intensivists have to deal with [35]. Rationing of medical equipment is a great dilemma ravaging

competing interests and Interprofessional perspectives [31]. In some countries, there have been Interprofessional rivalry between the different categories of health care workers and the clients and patients are the ones who suffer when such occur.
