Professional–Patient Relationships
Veracity
In biomedical ethics, responsibilities and virtues of authenticity were ignored. It was not recommended in the Hippocratic Oath or the Declaration of Geneva of the World Medical Association. It was defined for the first time in the Code of Medical Ethics of the American Medical Association. This document identified it as an aspect of inestimable value in medical description and narrative (Beauchamp & Childress, 2019).
It was further mentioned in AMA’s 1980 Principles of Medical Ethics, which emphasized honest attitude and communication in a professional setting. For a long time, the concept of reliability in the medical field has not been precisely defined or fixed. However, it is one of the essential characteristics of any specialist working in this field.
Obligations of Veracity
Reliability is defined as the timely, accurate, objective, and comprehensive provision of information and data and providing professionals with a complete understanding of what is happening for patients (Beauchamp & Childress, 2019). It includes several essential arguments that specialists must follow. The first implies wide-ranging respect for persons in many contexts. The second is based on connections to obligations of fidelity, promise-keeping, and contract, and the third is based on the role of trust in relationships between health professionals, patients, and subjects. The main issue with veracity becomes its conflicts with other obligations, such as those of medical benefit.
The Disclosure of Bad News to Patients
Disclosure of information about bad or unwanted news to patients may pose a problem regarding reliability. There are some circumstances under which nondisclosure or partial disclosure is justified due to cultural traditions or philosophical accounts. The policy of disclosure of bad news to patients has undergone significant changes throughout the years. Studies have shown that several factors influence this decision: age, wishes, emotional stability, and intelligence (Beauchamp & Childress, 2019).
At the same time, many specialists, especially in oncology, prefer not to disclose information to patients. Many of them inform only family members, which poses the question of what right a physician is to initially disclose information to a family without the patient’s acceptance of this arrangement. This becomes a problem because leaving the patient in the dark is unethical if he has autonomy. Moreover, individuals can prohibit informing family members about the diagnosis.
Disclosure of bad news is a critical aspect of gaining informed consent. However, medical specialists could manage this process responsibly by limiting or staging disclosure. Several arguments support incomplete patient information in cases with serious diagnoses.
The first focuses on the fact that disclosing bad news can violate obligations of benefit or nonmaleficence by causing deterioration of the patient’s psychological state and treatment outcomes. The second argument is that not all individuals can understand and comprehend the information provided to them. The third argument focuses on not all patients wanting to know their serious diagnosis.
Deception of Third-Party Payers
One reason for withholding bad news is the desire to avoid the costs of health care, which may affect third-party coverage. Further, many specialists resort to deception or exaggeration to get patients’ insurance to cover the costs of treatment. At the same time, this can have serious consequences for all parties involved. Therefore, medical professionals should look for alternative, nondeceptive action, such as formal appeals, and challenge unduly restrictive systems.
Privacy
Privacy in Law and Legal Theory
Privacy in modern medicine has become more of a concern than privacy itself. Privacy represents the protection of such valuable aspects as the concealment of private information and the decisions of individuals from government interference (Beauchamp & Childress, 2019). Therefore, the personal lives of individuals are protected from public intrusion. In other words, privacy can be interpreted as limited physical and informational access rights and decisive freedom.
The Concept of Privacy
Privacy is protecting an individual’s personal information from external interference and access to it by other agents. It can be informational, physical, decisive, propriety, relational, or associational (Beauchamp & Childress, 2019). Thus, privacy can protect not only personal information6 but also bodily products and objects or materials intimately associated with the person. In medical services, the definition of this concept is of critical importance since it delimits which access is considered a violation of a patient’s personal life.
Justification of the Right to Privacy
Privacy is on par with such fundamental human rights as life, liberty, and property. Therefore, the first justification for the existence of this concept is the components of a standard cluster of human rights. However, this approach is based on such rights with an uncertain status, which calls this approach into question. The second justification is that privacy is instrumental in personal development, intimate social relations, and personal freedom (Beauchamp & Childress, 2019). The third justification is the presence of the necessary respect for a person’s autonomy, which is manifested in the permission or refusal to access personal information.
Specifying and Balancing Rules of Privacy for Public Health Surveillance
Surveillance for public health purposes is one of the areas of consideration regarding the privacy of patients’ personal information. This process consists of collecting data that can be used for research purposes and aiding in the development of strategies and policies to improve public health and assistance measures. However, the main concern is that examination data requires the personal information of patients, which can become a violation of privacy. This is because, in many cases, information about patients can be used without their knowledge and informed consent.
The right to preserve patient privacy in the case of surveillance for public health purposes is not absolute but requires balancing against other ethical principles and rules. To do this, it is necessary to consider such factors as the importance of the goal being thought of, the probability of its realization, the necessity of the infringement of privacy, and the adequacy of adequate security measures (Beauchamp & Childress, 2019). Therefore, the development of rules for maintaining or violating privacy requires public engagement with all relevant stakeholders.
Confidentiality
Traditional Rules and Evolving Practices
Privacy is closely related to the concept of privacy. It consists of building a relationship in which an individual disclosing personal information expects its recipient not to further disclose the information to anyone without permission (Beauchamp & Childress, 2019). It follows from this definition that the main difference between confidentiality and privacy is the violation of the safety of someone else’s personal information and data.
The basis for building rules regarding confidentiality was enshrined in the Hippocratic Oath and continues in the creation of specialized codes for medical professionals. However, now they are more ceremonial in nature, which leads to the cultivation of the culture of the value of individuals’ personal data. The main task of medical specialists is to provide a detailed and understandable explanation to individuals of reasonable expectations for confidentiality and privacy in different healthcare contexts.
The Nature of Medical Confidentiality
Medical confidentiality is an important topic to consider separately. In this context, if the patient consents to the release of the information to others, then no violation of the rights of confidentiality occurs. On the other hand, this process causes a complete loss of both confidentiality and privacy. There are justifiable exceptions or limits to the kind of information that can be considered confidential in policy and practice.
One of these aspects is the legal rules and regulations that define the contexts of information disclosure. An example is reporting on the presence of serious wounds or a dangerous psychological condition in the workplace. Contracts that restrict the disclosure of personal information should be well-known to all employees and parties involved.
The Justification of Obligations of Confidentiality
There are two arguments that allow conducting activities without observing the rules regarding confidentiality. The consequence-based argument is that patients may decide not to disclose personal data due to a sense of distrust of the healthcare provider. This is because they may be afraid that what they tell the specialist may be disclosed to third parties. The problem is that without this information, medical professionals cannot prescribe the most effective solution for prescribing treatment.
The second argument focuses on autonomy and privacy rights. It is based on the rights of both autonomous choice and privacy to justify the rights of confidentiality jointly.
Justified Infringements of Rules of Confidentiality
Infringements of Rules of Confidentiality can be justified in cases where it is possible to harm the third party. There is a need to assess how much risk can stand between these participants in the process. It includes the evaluation of the probability and magnitude of possible harm (Beauchamp & Childress, 2019). There is also a permissive approach, which is based on the permission of the clinician to breach confidentiality under some circumstances but is not obligated to do so. However, the problem with this method is that it does not fully assess the possible harm to third parties.
Particular importance should be given to the disclosure of information regarding HIV status or genetic information to avoid or mitigate harm. In the United States, medical professionals are required to provide information about the HIV status of patients to public health departments. There are also many reasons why infected individuals should disclose this knowledge to their sexual partners.
The most important of them is the provision of risk to other individuals and harm to their well-being (Beauchamp & Childress, 2019). On the part of medical professionals, their task becomes an attempt to convince patients that they refuse to disclose this type of information about their health. Furthermore, they must comply with state and local guidelines regarding public health reporting and disclosure of HIV status.
Regarding genetic diseases, individuals face a moral principle when it is necessary to disclose this information. This is necessary to reduce the risk of transmission of this kind of deviation to their descendants. The goal of healthcare providers is to stress this obligation to their patients or clients.
However, directive counseling differs from the disclosure of information to relatives against the counselee’s explicit directive. According to the US Institute of Medicine Committee on Assessing Genetic Risks, confidentiality when disclosing information about a genetic disease can be violated for several reasons. They become problems with voluntary disclosure, high probability of irreversible harm, the possibility of its prevention, and the disclosure is limited to the information necessary for diagnosis or treatment, and no other way to limit the harm (Beauchamp & Childress, 2019). It is worth noting that medical professionals have a duty to respect the confidentiality of the patient.
Fidelity
The Nature and Place of Fidelity
Fidelity is also one of the main concerns about ethics within healthcare. It occurs when a significant fiduciary relationship is created between healthcare providers and patients (Beauchamp & Childress, 2019). Within this aspect, fiduciary healthcare professionals are obligated to be faithful for the benefit of others, which consists of making a promise to refrain from or perform this or that activity. In this case, there is a conflict between fidelity and divided loyalties, which manifests itself in helping with the intent to get other benefits besides caring for a particular patient. This may be a desire to receive compensation or serve social purposes beyond the individual patient’s interests.
Another aspect is the involvement of a third party due to the conflict between the roles and responsibilities of medical providers. The next conflict is the ambiguity as to what the health care professional owes the “patient” and the nursing conflict when the decision is made by some specialists and performed by others.
Problems of Conflict of Interest
Conflict of interest is one of the critical issues in the implementation of the fidelity concept. When a professional’s personal interests, such as his financial interests or friendships, can unduly influence his judgments, decisions, or actions, this creates a conflict of interest that an unbiased observer would recognize. In other words, it causes concern because of the possibility of bias and temptations. The risk of a conflict of interest may arise due to undue influence on judgments, decisions, or actions of a medical professional or the magnitude of harm that may occur as a result (Beauchamp & Childress, 2019). The threat of a conflict of interest is caused not only in practice but also when interacting with third parties in the process.
The Distinction between Clinical Ethics and Research Ethics
The Place and Significance of “Generalizable Knowledge”
There is a significant difference between clinical and research ethics, which are based on the difference between clinical practice and clinical research. Moreover, when conducting research work, there is also a difference in how individuals perceive and interpret information. The ethics committee should review both activity data in cases where they may expose participants to harm. The boundaries between research and practice are often blurred, and some areas of medicine use innovative techniques that lack regulatory approval. This suggests that patients treated with such techniques are subjects of research, even if no effort is made to produce generalizable knowledge.
The Dual Roles of Clinician and Investigator
Medical professionals have a duty to preserve and consider the well-being of patients during their studies. Thus, the clinical investigator acts within the interest of the individuals involved, and the research investigator is based on acts to generate scientific knowledge to benefit individual patients and populations (Beauchamp & Childress, 2019). It is worth noting that each of these researchers must comply with the goal of valuable knowledge, a reasonable prospect of the research, the necessity of using human subjects, a balance of potential benefits and risks, proper selection, and protection of privacy and confidentiality (Beauchamp & Childress, 2019). Therefore, they will be able to ensure benefits for both the subjects involved and the population.
Conflict in Clinical Trials
When conducting clinical trials, several conflicts may arise that may harm their conduct. The first is the problem of obtaining consent to receive a particular type of treatment. The following are determined by compliance with clinical etiquette and placebo control (Beauchamp & Childress, 2019). These issues arise in cases where important information regarding the methods of conducting a study and the use of a placebo is not disclosed if there is already a remedy that is effective in treatment.
It is noted that elevated informed consent does not by itself justify the use of placebo-controlled trials. Early termination of and withdrawal from clinical trials can also make it difficult to conduct a clinical trial (Beauchamp & Childress, 2019). In case the researcher thinks that a patient’s condition is at risk and that it is in the patient’s best interest to stop participating in the research, then the doctor should be able to act on behalf of the patient and suggest that they withdraw from the study.
Justifying Conditions for Randomized Clinical Trials
Randomized Clinical Trials have several substantive and procedural conditions that must be observed. They include the involvement of relevant and impartial medical experts, proof of the effectiveness and necessity of the study, and the absence of any conflict of interest. In addition, these justifications are based on obtaining informed consent, using placebo treatment in the absence of an effective alternative, and ensuring patient safety and the possibility of withdrawal.
Reference
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics. Oxford University Press.