CHAPTER 2: HEALTHCARE ETHICS

INTRODUCTION

Healthcare ethics is the application of ethical principles to help solve dilemmas in patient care. Chapter 2 covers:

• A brief overview of the evolution of healthcare ethics

• The basic governing principles of healthcare ethics

• The integral role nurses play to ensure ethically sound, interdisciplinary patient care

THE EVOLUTION OF HEALTHCARE ETHICS

The birth of medical ethics can be dated back to the fifth century BC, beginning with Hippocrates' compositions, such as Epidemics I (Jonsen, 2000). Other works written during this time period detail philosophies regarding disease and healing. Parts of these writings included directives on expected behavior by the physician when evaluating and treating the sick. The Hippocratic oath, still taken by physicians upon graduation, has its roots here as well (Jonsen, 2000). Ethical guidance is introduced in other texts from this time period with themes of applying medicine for healing, not harming patients, recognizing when disease has progressed too far for treatment to be effective, providing comfort, and not hastening death through the administration of poison (Jonsen, 2000).

Medical ethics continued to develop over the centuries. During the Middle Ages, the beginnings of formalized physician educational preparation developed, including payment for professional medical treatment. Decrees were written to prevent exploitation of the poor and to prevent business agreements between apothecaries and physicians. In addition, physicians were strongly encouraged to denounce fabricated remedies. Medical ethics-related literature also emerged in Middle Eastern medicine at this time, with the Islamic publication of Practical Ethics of the Physician. Far Eastern medicine also detailed ethical practices in the writings of Nei Jing, a collection of writings similar to those of Hippocrates (Jonsen, 2000).

From the 14^th to the 18^th centuries, Catholic theologians delved into analyses of medical care, affirming that physicians are not required to sustain life with futile treatments—the first profound declaration of its kind admonishing extraordinary means to preserve life. There was also condemnation of patient exploitation in terms of continuing unnecessary treatment, deceiving patients with improper treatments, or charging for advice simply for financial gain. The literature of this time touted the trusted relationship between physician and patient, one in which the physician was an authoritative and paternalistic figure (Jonsen, 2000).

Development of healthcare ethics grew during the 18^th and 19^th centuries in Great Britain, with further exploration of moral boundaries in medical care. Dr. Thomas Percival's Medical Ethics, a novel work at the time, was an essay that addressed areas such as the physician's professional conduct in private practice, hospital duties, relationships between the physician and the apothecary, the laws of the state as they applied to medical practice, and the moral duty to provide equitable care for patients despite financial or social status. The delivery of moral medical care was also encouraged by Dr. John ...