Table 2.
Application of principles of ethics in patient care
| Beneficence, | Clinical assessment |
| nonmaleficence | Nature of illness (acute, chronic, reversible, terminal)? Goals of treatment? |
| Treatment options and probability of success for each option? | |
| Adverse effects of treatment and does benefit outweigh harm? | |
| Effects of no medical/surgical treatment? | |
| If treated, plans for limiting treatment? Stopping treatment? | |
| Respect for autonomy | Patient rights and preferences |
| Information given to patient on benefits and risks of treatment? Patient understood the information and gave consent? | |
| Patent mentally competent? If competent, what are his/her preferences? | |
| If patient mentally incompetent, are patient's prior preferences known? If preferences unknown, who is the appropriate surrogate? | |
| Beneficence, | Quality of life (QOL) |
| nonmaleficence, | Expected QOL with and without treatment? |
| respect for autonomy | Deficits − physical, mental, social − may have after treatment? |
| Judging QOL of patient who cannot express himself/herself? Who is the judge? | |
| Recognition of possible physician bias in judging QOL? | |
| Rationale to forgo life-sustaining treatment(s)? | |
| Distributive justice | External forces and context |
| Conflicts of interests − does physician benefit financially, professionally by ordering tests, prescribing medications, seeking consultations? | |
| Research or educational considerations that affect clinical decisions, physician orders? | |
| Conflicts of interests based on religious beliefs? Legal issues? | |
| Conflicts of interests between organizations (clinics, hospitals), 3rd party payers? | |
| Public health and safety issues? | |
| Problems in allocation of scarce resources? | |