The “do no harm” principle is what doctors learn in their very first lesson. And no wonder - they should not do worse in the first place. This is evidenced by the translation from the original language "primum non nocere" - "first do no harm." Usually the authorship of the principle is attributed to Hippocrates. This is the oldest principle of medical ethics. But, besides him, there are a number of other developments in this area.
Introductory information
Initially, let's figure out where you can get quality information about the subject of the article. Studying in the framework of state courses is the most preferable, since in this case the training of doctors is carried out on the basis of medical schools and universities. Here you can always find specialists who intelligibly and professionally deliver material to students. You must admit that doctors with great experience and practice understand human ailments very well, as well as in the processes of their healing. Topical in the framework of this article is the issue of bioethics. This is the name of the problem area. Moreover, they are not only informative (that is, those that require reflection), but they cannot do without sufficiently serious actions and decisions. The immediate source of the problems considered by bioethics is the rapid progress of the biomedical sciences and technologies, which has become very characteristic of the last third of the twentieth century. At first glance, this statement may seem ridiculous. After all, it affects exactly what was conceived and done now with unconditionally good goals - alleviating the suffering of a person, improving the quality and duration of his life. And this is the source of the problems. Moreover, they are considerable - they cause serious discussions and numerous disagreements. When you have to solve them, then responsible specialists need to be guided not only by traditional arguments, but also by value attitudes adopted by behavior models and emotions.
Now it can be argued that bioethics as an area of research, moral decisions and public discussions only takes its first steps. It should be noted that there is a wide variety of different ethical theories. The most recognized concept, which was developed by American experts James Childress and Tom Beechamp. It provides for the promotion of four fundamental principles. In total, it is compact, systematic, convenient for perception and understanding.
First principle: do no harm
This is the most important point in the work of a doctor. As previously considered in the full version of the dictum - "do no harm first." That is, this is the most important thing. But in this case, the following question comes to the fore: what is meant by harm? In the case of biomedicine, this applies to the activities of a doctor and the construction of his relationship with patients. Then we can distinguish the following forms of harm:
- Caused by inaction, refusal to help someone who really needs it.
- Caused by selfish and malicious intent, dishonesty.
- Originating in incorrect, unruly or unskilled actions.
- Caused by actions objectively necessary in a specific situation.
In the first situation, the problem is associated not only with the moral, but also with the legal / administrative side. Indeed, failure to provide assistance is associated with failure to fulfill obligations stipulated by law or regulatory documents. Suppose that a doctor on duty does not perform certain actions that a particular patient needs. In this case, he is responsible first for failure to fulfill obligations, and then for the consequences that arose due to inaction. This situation is partially helped by the fact that at the right time, the doctor simply helped, spending his time and energy, to another person. It is also a completely different matter if the doctor is not in attendance. In this case, he can calmly resolve himself. But from a moral point of view, such inaction is reprehensible. For example, in the USA, a professional association for such actions sometimes deprives a license that grants the right to practice medicine.
We continue to consider the first principle
And now we move on to the next point, talking about the harm caused by dishonesty. This is also more interesting from an administrative point of view than from an ethical point of view. Although such an approach certainly deserves moral condemnation. An example is the situation when the doctor is simply lazy to perform the required procedure. Or, if he is busy with it, he is not doing well enough.
The next form of harm is this one that is caused due to insufficient qualifications. By the way, the following words will be useful to everyone who may someday help other people. Remember the “do no harm” rule! If there is an injured person nearby, it is necessary to help him within the framework of which there is confidence that it will become better. To do something, having only a general idea, and not yet having sufficient qualifications, is to complicate the situation. It is better to transfer the person into the hands of specialists. Refer more qualified staff for inspection. This is a very important point, which includes the principle of "do no harm." Bioethics also considers that a person who has received the qualifications of a doctor, but does not know how to do the necessary things, deserves moral condemnation.
And the fourth form is objectively necessary harm. For example, during hospitalization this is a limitation of opportunities. The prescribed procedures can be painful, for example, if you need to break the bone again, because the last time it fused poorly. All this is done for the good. In this case, the principle of “do no harm” should be seen as a call to minimize harm. Only what is necessary is permissible.
Second principle: do good
It is a continuation of the previous one and expands its content. “Do good” (in another translation “do good”) - this is no longer a ban, but the establishment of a kind of norm, the achievement of which requires the commission of certain positive actions. The principle involves the use of not so much rational considerations as feelings and emotions, such as pity, compassion. In this case, attention is concentrated not on the need to avoid harm, but on active actions to prevent or correct it. But since it is extremely problematic to demand self-sacrifice and extreme altruism from a person, this principle is perceived as a kind of moral ideal, and not an obligation. Although we should not forget that the goal of healthcare is to ensure the health and life of patients. For example, when mankind understood how diseases such as plague and yellow fever should be prevented, the very natural result was that positive actions had been taken. They consisted in the adoption of special prevention programs that can minimize or even cancel (as with smallpox) the circulation of these diseases. Then, if the necessary measures were not taken, it would be morally irresponsible.
Another aspect of the principle under consideration is the content of the created good. Medical paternalism provides that a doctor can rely solely on his own judgment about the patient's needs for counseling, information and treatment. She (this position) justifies coercion, hiding information and deceit, if this is done for the good.
The third principle: respect for patient autonomy
In biomedical ethics, he is currently one of the fundamental. This principle calls into question the exceptional and unconditional competence of the doctor in determining the benefits for the patient. It is envisaged that only an autonomous person must make a choice. But only where it is. In this case, you must also remember the responsibility. But at the same time it will be useful to know what kind of action can be considered autonomous. The one who implements it must act deliberately. In other words, he must have a certain plan, an understanding of what he is doing, the absence of external influences that can affect the final result. For example, when a doctor offers his patient a certain surgical operation, then the second does not have to have all the knowledge necessary for her to make an autonomous choice. It’s enough just to understand the essence of the matter. Ultimately, the patient can agree or not to the proposal received. In the first case, he accepts the doctor’s intentions, making them his own decision. This principle of the code of medical ethics is based on the view that the human person is self-valuable regardless of the circumstances. It should be noted that respect for patient autonomy is not necessary when it comes to special categories. These are children, patients with mental illnesses, people in a state of drug or alcohol intoxication, and the like.
Fourth Principle: Justice
This principle of medical ethics, perhaps, causes the most heated debate. It can be formulated as follows: everyone can count on receiving what is due to him. Health protection can be designed for both an individual and their group, allocated on one or another basis. For low-income citizens, a social allowance is provided. This is fair. If support is provided to all groups of the population, then this principle is violated. By the way, its difference from those considered earlier is that the assessments, decisions and actions of doctors do not affect a specific person, but different people or even entire social groups. The principle of justice is not absolute, but relative.
Consider an example. There was a situation with a transplant of a donor organ. At the same time, there is a patient who takes a more distant place in the waiting list, but he has a critical situation. In this case, you can compromise the obligations that follow from the principle of justice and be guided by the do not harm. After all, the main task is to protect the health and life of people! Although compliance with the queue can be abandoned under the influence of the principle of justice, in this case they turn to the criterion of need and proceed from its current severity. When following this principle, it is necessary to take into account the existing relationships that form a social network between doctors, nurses, social workers, administrators and patients. After all, this affects individual, group and state interests that are intertwined with health issues.
Truth rule
Professional doctors build their activities not only on fundamental ethical principles. They supplement them with other norms. Among them, the so-called rules play a special role. Doctors training includes them on a par with principles. And the first among them is the rule of veracity. It states that the interlocutor needs to communicate information that, from the speaker’s point of view, is true. Sometimes it is interpreted in the form of a ban on the message of lies. Faithfulness is a necessary condition for normal communication and social interaction. The philosopher Kant wrote that it is the duty of man to him as a moral being. And lying to oneself is equal to annihilation. To be honest (truthful) in all situations is to represent the sacred commandment of the mind, unconditionally commanding and not limited by any external requirements.
It should be noted that the balance of values cannot be predetermined a priori by creating some kind of rule. But it is always necessary to remember that the right to speak the truth is not unconditional. The privacy of other people is the most important norm and moral value of modern civilized communities. A position that suggests even difficult and truthful communication with people whose condition can be described as critical is considered more preferable. Not without a dilemma here. For example, whether for the sake of purity of moral principles and rules of healing to refuse therapeutically effective deception to ban the use of placebo.
On Confidentiality and Informed Consent Rule
Medical confidentiality is another work that is actively maintained to ensure the safety and convenience of patients. Confidentiality is designed to protect doctors and patients from intrusion from the outside, which was not authorized by the direct participants. In this regard, one point is important. Namely: the information that the patient passes to the doctor, as well as the patient’s data obtained during the examination, should not be transmitted without the consent of the person whose body condition they characterize. Why is this so important? The fact is that disclosing confidential medical information can complicate a person’s life. This is manifested in relation to others, their decisions and a number of other cases. And very often people become slaves to delusions. That is, they think that something is connected with a certain disease, which in fact has nothing to do with it. For example, it is a statement that the immunodeficiency virus is transmitted through dishes. But in fact, he "travels" through human fluids, and if hygiene is maintained at the proper level, then nothing is threatened.
Confidentiality is the informed consent rule. It is necessary to ensure respect for patients or subjects in biomedical experiments as individuals by medical professionals. It also helps to minimize threats to their health, moral values, and their socio-psychological well-being due to irresponsible or dishonest actions on the part of specialists. The application of this rule allows for the active participation of the patient in choosing a treatment method that is optimal not only in terms of medical effectiveness, but also the life values of the person himself.
About the relationship between doctors and patients
In short, there are four models of healing. They are distinguished by the leading moral principle that the medical worker adopts:
- Paracelsus model. It is consonant with the second principle of "do good."
- Hippocrates model. It is consonant with the first principle of “do no harm”.
- Deontological model. Built on the idea that it is necessary for the healer to fulfill his duty.
- Bioethical model. Provides respect for patient autonomy in the first place.
It should also be noted that the relationship between a specific doctor and patient is subject to typification depending on the formed nature of moral and psychological ties. As a well-known sample, we can cite the results of Vich:
- Paternalistic models. It provides for the attitude of the doctor to the patient as a son. A separate option is the sacred (sacred) model. It provides that the patient perceives the doctor as a god.
- Not paternalistic models. Three types are distinguished here. The first model is an instrumental (technocratic) one. In this case, moral and psychological relationships are minimized. As a rule, it can be observed when visiting narrow specialists. The next model is collegial. In this case, it is provided that the patient and the doctor can discuss current health and life issues almost like medical staff. And the latest model is a contract. She is most popular in paid medicine. Provides for strict adherence to a previously concluded contract.
About the Hippocratic Oath
How did it all start? Readers are probably interested to read what the Hippocratic oath in Russian is:
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I will direct the regimen of patients to their benefit in accordance with my strength and my mind, refraining from doing any harm and injustice. I will not give anyone the lethal remedy requested from me and show the way for such a plan; likewise, I will not hand any woman an abortive pessary. I will spend my life and my art purely and immaculately. In no case will I make sections for those suffering from stone disease, leaving this to the people involved in this matter.
Whatever house I enter, I will enter there for the good of the patient, being far from everything that was intentional, unrighteous and destructive, especially from love affairs with women and men, free and slaves. So that during treatment, as well as without treatment, I neither see nor hear about human life from something that should never be disclosed, I will keep silent about considering such things a secret. I, indestructibly fulfilling the oath, may I be given happiness in life and in art and glory among all people for eternal times; He who transgresses and gives a false oath, let the opposite be true.
Conclusion
So it is examined what bioethics is in general terms. If you are interested in the details of the formation of such a worldview, then you can visit the museum of the history of medicine. And one can observe in it how the drug business developed from the most ancient times.
By the way, do you know when the day of the medical professional? Well, he will be very soon - June 16th. Knowing when the day of the medical worker, it will be possible to thank the friends of the doctors for all the work that they do, saving and supporting our lives.