**12. Principles of medical ethics**

Since the olden days, it is believed that the doctor knows it all and also knows the best [41]. These have been challenging as there is an increase in litigation against doctors, practice and implementation of ethical principles helps as the preventive measure against such medical litigation and jurisprudence. Modern medicine is faced with several ethical problems [29]. Some of these problems can be abated by ethical principles. Clinicians try to do their best for their patients by providing the best medical care available. These ethical principles guide physicians in decision making in the course of their work especially where there are ethical dilemmas and helps in the resolution of ethical conflict [27]. Hence physicians generally act in the

best interest of their clients and patient though conflict may sometimes occur as they weigh the risks and benefits of all available choices but act in the best interest of the patient [2, 27]. The principles of medical ethics [3, 4, 10, 27] are:


#### **12.1 Autonomy**

The fundamental principle of medical ethics is autonomy [42] Autonomy is the freedom of patients and clients to make their decisions on their conditions without the interference, pressurization and duress. It means giving adequate information to the patient respectfully and disclosure of information about a patient after obtaining informed consent to do so [4, 43, 44]. Trust is always key in every doctor patient relationship as the patient rusts the doctor to the best for him or her therefore the patient is entitled to autonomy. It is the duty of the doctors to counsel and explain to the patient the diagnosis, proposed management and treatment options. The doctor is not expected to impose any decision on the patient. Hence, the freedom of thought, intention and decision making process especially in the new era of shared decision. For this to be complete, the patient should be counseled in simple language so that they understand the risks and benefits of the procedures. This is also the principle for not to do evil or inflict harm. Autonomy allows the freedom of choice and action by the patient. The principle of autonomy requires the physician should provide all available therapeutic options to the client [21]. This also shows that the patient even after all the counseling has the right to refuse and reject treatment [10]. Ethical principles are affected by cultural and traditional beliefs and practices. Some cultures frown against being told that the clinical condition is poor worst is if death is anticipated. Since time immemorial, doctors have been faced with the notion of to what extent and how much clinical information should be released to a patient especially when it is bad news [45]. This is in conflict with the ethical principle of autonomy for which people should be allowed to make their decisions without any influence or been coerced to do so. The other medical ethical principles of truth telling, and confidentiality including informed consent are all based on autonomy [4]. Autonomy allows the patient to choose from every available treatment options depending on their goals and values [41, 44, 46]. Although sometimes doctors are able to convince their patients to accept what they believe is the best for the patient [41]. Autonomy therefore makes patients to be responsible for their health needs and wishes [11].

#### **12.2 Beneficence**

The principle of beneficence is that everything done by the medical practitioner should be in the best interest of the patient [4, 10, 47]. Therefore this guides the decision making process of the physician. This means that all negative options

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*Medical Ethics*

**12.3 Non-maleficence**

**12.4 Justice**

of health resources [10].

**12.5 Confidentiality**

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

which will not be in the best interest of the patient should not be offered to the patient. An example is administering a medication to a patient because of the side effect of the drug. The summary of beneficence is to do good always. Though every physician has to practice the ethical principle of autonomy, options that shall be beneficial to the patient should only be offered to be patient [47]. This ethical principle is implemented in the choice of drugs as all medications have adverse effects some of which may be mild which can be tolerated while some others are severe

The ethical principle of non-maleficence is related to beneficence but they are different [44]. The principle of non-maleficence states that no harm should be done to the patient or other people in the community [4, 9, 10, 17, 48]. Implementing the principle of non-maleficence means that any treatment option that will be harmful to the patient should not be offered to the patient [44] as the patient will also exhibit autonomy. Hence the patient's medical condition may worsen. Violation of non-maleficence can lead to litigation and malpractice. Negligence is a consequence of the violence of non-maleficence. Medical error can result in non-maleficence. This also applies to research in which the research protocol must be reviewed by an institutional review board so that none of the research participants suffer harm. All the benefits, risks and consequences of all treatment are weighed in the course of the medical consultation [49]. It is the duty of the physician to protect their patients [48]. Though all health practitioners encounter ethical challenges in the course of

which can worsen the clinical state and can even cause death.

their work, the principle of not to do harm is always a priority [17].

Justice requires fairness in the management of patients and distribution of resources especially in the time of scarcity and when priority needs to be maintained such as during mass casualty and pandemics. Individuals at all time should be treated fairly when they visit a health facility [10]. The distribution of health resources requires justice for it to be done fairly and equitably [1, 4, 19, 47]. Justice is also necessary in respecting the rights of patients [19]. In times of scarcity, the ethical principle of justice is used to determine areas of priority in the distribution

Confidentiality and privacy generally is required in any human relationship [43]. A physician is expected to maintain confidentiality of all discussions made with the client or patient [50]. The physician requires permission and consent of the patient before divulging such information to any other person even among fellow physicians and health care professionals. The ethical principle of confidentiality is related to other ethical principles of autonomy and truthfulness. Patients trust their physicians hence that can open up their privacy to the doctor and trust that the doctor will keep secret all information confided in him or her to be private. Patients and their caregivers hold different preference in the disclosure of medical information about them or their loved one to third parties [44]. The ethical principle of confidentiality is based on trust hence patients trust the clinician therefore they tell them the truth and except the doctor to keep it private to themselves only without their authorization or informed consent [4, 43, 51]. Part of a patient's right dwells on the physician respecting patient confidentiality. Trust in the patient doctor relationship

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

which will not be in the best interest of the patient should not be offered to the patient. An example is administering a medication to a patient because of the side effect of the drug. The summary of beneficence is to do good always. Though every physician has to practice the ethical principle of autonomy, options that shall be beneficial to the patient should only be offered to be patient [47]. This ethical principle is implemented in the choice of drugs as all medications have adverse effects some of which may be mild which can be tolerated while some others are severe which can worsen the clinical state and can even cause death.
