Chapter 21

### I. INTRODUCTION

Ethics is a term that describes “doing good.” The study of bioethics as a field separate from medicine itself is a recent phenomenon. Physicians have historically set and maintained policies concerning ethical behavior in medical practice. During the last 30 years, the distinct study of bioethics has come into being. The obligation to act in an ethical manner in medical practice requires that we know something about how we should act and what internal and external guidelines should be followed to accomplish that end. Bioethical issues should be examined from the perspectives of the patient and family, the physician, and society as a whole.

### II. BIOETHICS PERSPECTIVES

1. The patient. Patient-centered bioethics deals with basic principles in which every interaction should be filtered. This protects patients in their more vulnerable position and allows equal treatment. The principles that govern physician–patient interaction are respect of autonomy, nonmaleficence, beneficence, and justice.

2. The physician. Despite an increasing public distrust of physicians' motives, the practice of medicine requires physicians to perform in an exceptionally professional manner. Indeed, the very idea of “professional” is closely linked to good conduct and virtuous behavior. Several important virtues make the practice of medicine a profession as opposed to everyday work.

1. Fidelity to trust. Trust is an important virtue in any human relationship. This involves not only truth telling but also aspects of consistency, integrity, and confidence. The medical relationship between physician and patient extends even further into this idea of trust. The relationship between professionals such as physicians, lawyers, and ministers is termed a fiduciary relationship. In such a relationship, the patient trusts the physician to help the patient, and the physician is expected to provide this help to the best of his or her ability. In other words, as physicians, we should always be found trustworthy.

2. Compassion. If there is one aspect of a physician's character most scrutinized by patients, it is compassion. Compassion, although difficult to define precisely, is the quality most associated with ethical behavior. The word compassion (com meaning “with” and passion meaning “suffering”) literally means to “suffer with” your patient.

3. Phronesis. The term phronesis was used by Aristotle for the virtue of practical wisdom, the capacity for moral insight, the capacity, in a given set of circumstances, to discern what moral choice or course of action is most conducive to the good of the agent or the activity in which the agent is engaged. In short, phronesis can be defined as “common sense.”

4. Justice. It is defined as “the rendering to one what is due.” As physicians, we have a specific obligation to render to our patients what is due: the patient's healing. The virtue of justice also indicates an unfailing quality. This quality is linked to the rule of nonmaleficence or the avoidance of doing harm to the patient.

5. Fortitude. Describes not only physical but also mental and emotional courage. We tend to think of courage ...

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