Medical Ethics: Context Is the Key Word

John Myers

Wellspring’s Universal Environment P/L, Melbourne, Australia.

DOI: 10.4236/ijcm.2014.516134                

Abstract

Medical Ethics is no different to Ethics, but relates specifically to the doctor-patient relationship. This relationship is based on mutual trust—trust in the doctor’s expertise and knowledge and trust that the patient is consulting the doctor, for his/her/their own health, wellbeing and welfare, without agenda or bias. In other words, the basis of the doctor-patient relationship is one of mutual trust and confidence. Thus, what is imparted between them is held in the strictest confidence. The doctor must act within the law. No third party influence can be brought to bear on this relationship without the patient’s consent. In the case of minors the relationship is between the child’s guardians as well as the doctor who must act within the law. In the category of “elderly” or adult guardianship or advocacy, those appointed and in positions of trust must take the person’s wishes into account if the patient has capacity to make decisions or has indicated their wish prior to any such appointment. Capacity is defined as consistent belief or wish, awareness of what one does not wish for, satisfaction when wishes are respected and fulfilled and the opposite when they are not. Ethical practice is determined by taking context into account in decision-making and ensuring the sanctity of the patient’s rights and wishes. Abuse is just the opposite, where actions taken or not taken are against a person’s wishes. Personal wish determines best interest. Best interest may also be defined in terms of social functioning and psychological wellbeing. Discussion of ethics in terms of General Systems Theory is also addressed, and affects an action on the environment or others, i.e. ethics in the wider medical context may pertain if the person has a contagious disease and a period of quarantine or “isolation” or barrier” nursing is required, and where precedent is given to society’s best interest over the person’s wishes, as part of an educational process and as required for strategic disease management.

Keywords

Medical Ethics and Context, Rights, Behaviour and Abuse

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Deuteronomy 5:6-18 (2009) The Ten Commandments. In: Scherman, N. and Zlotowitz, M., Eds., The Chumash, The Stone Edition, ArtScroll Series®, Mesorah Publications, New York, 969-971.
[2]	Noahide Laws (2014) http://creationwiki.org/Noahide_law
[3]	Hillel. In: The Babylonian Talmud, Tractate Shabbat, 31a.
[4]	Myers, J.B. (2007) “Duty to Care”, Or, “Duty of Care” and the Goal of Medical Treatment. Internal Medicine Journal, 37, 211. http://dx.doi.org/10.1111/j.1445-5994.2006.01306.x
[5]	Myers, J.B. (2006) Ethics and Professional Medical Opinion and Guardianship and Administration Legislation. Internal Medicine Journal, 36, 540-541. http://dx.doi.org/10.1111/j.1445-5994.2006.01111.x
[6]	Myers, J.B. (2010) Clinical Indicators: The Role of Patient in Goal Setting, Evaluation and Ethical Practice. Internal Medicine Journal, 40, 244-246. http://dx.doi.org/10.1111/j.1445-5994.2009.02151.x
[7]	Myers, J.B. (2009) The Australian Medical Draft Code of Professional Conduct: Good Practice Or Creeping Authoritarianism? Medical Journal of Australia, 191, 190-191.
[8]	Myers, J.B. (2012) A System of Evaluated Decisions. Capacity Assessment: Who Can Decide? Australasian Journal on Ageing, 31, 67-83.
[9]	(2013) Ensuring Unbiased Democratic Decision-Making: Principles to Guide Good Practice. Department of Planning and Community Development. Victorian Government. J2,7; L5, 9; M2-3, 9-10. http://www.dpcd.vic.gov.au/__data/assets/pdf_file/0005/134483/2013-Ensuring-Unbiased-Democratic-Council-Decision-Making-April-2013.pdf
[10]	Deuteronomy 16:19 (2009) Ibid, 1025.
[11]	United Nations General Assembly (1991) Declaration of the Rights of the Elderly, approved by the United Nations General Assembly on 16 December: Independence, Participation, Care, Self-fulfillment, Dignity. Resolution No. 46/91.
[12]	The Law Reform Commission (2010) Guardianship, 17.49, 384. http://www.lawreform.vic.gov.au/sites/default/files/Guardianship_FinalReport_Full%20text.pdf
[13]	Myers, J.B. (2005) Submission: Elder Abuse Prevention. Office of Senior Victorians. 6 October 2005.
[14]	Myers, J.B. (2007) Submission to: House of Representatives Standing Committee on Legal and Constitutional Affairs Inquiry into Older people and the Law. LACA Reps. Parliament of the Commonwealth of Australia.
[15]	Myers, J.B. (2010) Protecting the Rights of the Aged and Individuals Referred for Health Care. ANZSPM (Australian and New Zealand Society of Palliative Medicine) Conference, Adelaide, 14-17 September 2010.
[16]	Myers, J.B. (2010) Ars Moriendi—Ars Vivendi—The Art of Living Life to the Full. ANZSPM (Australian and New Zealand Society of Palliative Medicine) Conference, Adelaide, 14-17 September 2010.
[17]	Hochachka, P.W. and Somero, G.N. (2002) Biochemical Adaptation: Mechanism and Process in Physiological Evolution. Oxford University Press, Oxford.
[18]	Myers, J.B. (1982) Biochemical Response to Change in the Environment and the Nature of “Essential” Hypertension. Medical Hypotheses, 9, 241-257. http://dx.doi.org/10.1016/0306-9877(82)90154-2
[19]	Myers, J.B. (2014) The Eco-Society or Eco-Social© Environment and Heart Disease. A General Systems Approach. PM358. World Heart Federation’s World Congress of Cardiology, Melbourne, 4-7 May 2014.
[20]	Myers, J.B. (2014) Cognition, Behavior and Brain Function—Ethics of the Mind and General Systems Theory. BIT’s 5th Annual World Conference of NeuroTalk-2014, Section 1-8, Nanjing, 16-18 May 2014, 104.
[21]	Buchanan, J. and Nettle, J. (2004) Decision. In: Myers vs. the Medical Board of Victoria (VSCA No. 7516).
[22]	Australian Council on Healthcare Standards (2013) EQuIPNational. http://www.achs.org.au/publications-resources/equipnational/
[23]	MacKee, N. (2013) Make Advanced Care Directives Routine. MJA Insights 44, 18 November. https://www.mja.com.au/insight/2013/44/make-advance-care-plans-routine
[24]	Myers vs. Medical Board of Australia (2013) SAT 59.
[25]	Myers, J.B. (2010) The Australian Commission on Safety and Quality—Double Standards of Health Care. Internal Medicine Journal, Supplement 1, 275.
[26]	Myers, J.B. (2013) Is The Future Direction in Health About Bureaucratic Self Interest or Creativity, Professionalism and Wellbeing? Rights and Responsibility Must Replace Quality and Safety in Health Care. Internal Medicine Journal, 43, 47.
[27]	Psalm 27:10. (2001) Tehillim Ohel Yosef Yitzchak. Kehot Publication Society, Brooklyn, New York, 33.
[28]	Myers, J.B. (2014) The Cement That Binds Us. Proceedings of 7th Making Cities Liveable Conference, Mantra on Salt Beach, Kingscliff, 10-11 July 2014.
[29]	Myers, J.B. (2011) Theoretical and Conceptual Advances. The Backlog of Trees. In: The 1st International One Health Congress, EcoHealth, 7, 1-2. http://dx.doi.org/10.1007/s10393-011-0676-z
[30]	Myers, J.B. (2008) Advanced Directive. Choice Based on Informed Consent. Internal Medicine Journal, 38, 455-456. http://dx.doi.org/10.1111/j.1445-5994.2008.01683.x