Medical ethics
Medical ethics is a system of moral principles that apply values to the practice of clinical medicine and in scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice.Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics.However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation.[4]
There are several codes of conduct. The Hippocratic Oath discusses basic principles for medical professionals.This document dates back to the fifth century BCE.Both The Declaration of Helsinki (1964) and The Nuremberg Code (1947) are two well-known and well respected documents contributing to medical ethics. Other important markings in the history of Medical Ethics include Roe v. Wade in 1973 and the development of Hemodialysis in the 1960s. More recently, new techniques for gene editing aiming at treating, preventing and curing diseases utilizing gene editing, are raising important moral questions about their applications in medicine and treatments as well as societal impacts on future generations.
As this field continues to develop and change throughout history, the focus remains on fair, balanced, and moral thinking across all cultural and religious backgrounds around the world. Medical ethics encompasses a practical application in clinical settings as well as scholarly work on its history, philosophy, and sociology.
Medical ethics encompasses beneficence, autonomy, and justice as they relate to conflicts such as euthanasia, patient confidentiality, informed consent, and conflicts of interest in healthcare. In addition, medical ethics and culture are interconnected as different cultures implement ethical values differently, sometimes placing more emphasis on family values and downplaying the importance of autonomy. This leads to an increasing need for culturally sensitive physicians and ethical committees in hospitals and other healthcare settings.
Doctor–patient relationship
Importance
A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important. Some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology, which have very little contact with patients.
The quality of the patient–physician relationship is important to both parties. The doctor and patients values and perspectives about disease, life, and time available play a role in building up this relationship. A strong relationship between the doctor and patient will lead to frequent, quality information about the patients disease and better health care for the patient and their family. Enhancing the accuracy of the diagnosis and increasing the patients knowledge about the disease all come with a good relationship between the doctor and the patient. Where such a relationship is poor the physicians ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice which results in bad health outcomes. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician that they trust more. Additionally, the benefits of any placebo effect are also based upon the patients subjective assessment (conscious or unconscious) of the physicians credibility and skills.
The following aspects of the doctor–patient relationship are the subject of commentary and discussion.
- Informed consent
The default medical practice for showing respect to patients and their families is for the doctor to be truthful in informing the patient of their health and to be direct in asking for the patients consent before giving treatment. Historically in many cultures there has been a shift from paternalism, the view that the 'doctor always knows best,' to the idea that patients must have a choice in the provision of their care and be given the right to provide informed consent to medical procedures.
- Shared decision making
Shared decision making is the idea that as a patient gives informed consent to treatment, that patient also is given an opportunity to choose among the treatment options provided by the physician that is responsible for their healthcare. This means the doctor does not recommend what the patient should do, rather the patients
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医德
医德是一套应用于临床医学实践和科学研究中道德原则体系。医德是专业人士在发生任何混乱或冲突时可以参考的一套价值观。这些价值观包括对自主权、非恶意行为、仁慈和公正的尊重，这些信条可以使医生、护士和家庭为了共同的目标而制定的治疗计划和工作。要注意的是，这四个价值不是按照重要性或相关性来排列的，它们都包含与医学伦理有关的价值。然而，对于整个医疗系统来说，可能发生的冲突导致这些价值需要一定的等级制度，从而使得某些道德元素能影响到其他，目的是对困难的医疗情况运用最佳的道德判断。
这是几种行为准则。希波克拉底学派讨论了医疗专业人员的基本原则。该文件的历史可以追溯到公元前五世纪。于1964年和1947年发表的《赫尔辛基宣言》和《欧洲人权宣言》是两个著名的、备受尊重的文件。它们是医德史上重要的标志。其他重要标志包括1973年和2003年的《欧洲人权宣言》和20世纪60年代的血液透析的发展。最近，旨在利用基因编辑治疗，预防和治愈疾病的基因编辑新技术，引起了关于其在医学和治疗中的应用以及对后代的社会影响的重要道德问题的讨论。
随着这个领域在历史上的不断发展和变化，世界各地跨文化和宗教背景的公正、平衡和道德思考的焦点依然存在。医德涉及到临床环境中的实际应用以及有关其历史，哲学和社会学的学术著作。
医德涉及自主权、公正对待安乐死、患者隐私、知情同意和医疗保健利益冲突等相关违法行为。 此外，医学伦理与文化是相互联系的，存在着不同的文化内涵和不同的价值观，有时更加重视家庭价值，而对自治的重要性轻描淡写。这就导致人们越来越需要对文化敏感的医生和医院及其他医疗机构的委员会。
医患关系重要性
患者必须对医师的能力有信心，并且感到自己可以对他或她倾诉。对于大多数医生而言，与患者建立良好的融洽关系很重要。一些医学专业（例如精神病学和家庭医学）要比与病人接触较少的专业（诸如病理学或放射学）更强调医患关系。
医患关系的质量对双方都很重要。医生和患者对疾病，生活和可用时间的价值观和观点在建立这种关系中起着重要作用。医生与患者之间的牢固关系使医生获得患者疾病的频繁、高质量的信息，并为患者及其家人提供更好的保健。提高诊断的准确性，提高病人对疾病的认识，都离不开医患之间的良好关系。如果这种关系很差，医生进行全面评估的能力就会受到损害，患者更可能不信任诊断和建议的治疗，导致实际遵循医嘱的遵从性降低，从而导致不良的健康结果。在医学意见确实存在分歧的情况下，可以寻求其他医生的第二种意见，或者患者可以选择他们更信任的另一位医生。另外，任何安慰剂效应的益处也基于患者对医师信誉和技能的主观评估（有意识或无意识）。
以下是关于医患关系评论和讨论的几个方面。
- 知情同意
对患者及其家人的表示尊重的默认医学做法是，医生如实告知患者健康，并在患者接受治疗之前直接征得患者的同意。 从历史上看，在许多文化中，已经从家长作风（一种“医生总是最了解”的观点）转变为患者必须在提供的医疗服务方面做出选择，并有权对医疗程序提供知情同意 。
- 分享决策
共享决策是指当患者在知情的情况下同意治疗时，也有机会在负责其医疗保健的医生提供的治疗方案中进行选择。这意味着医生不推荐病人应该做什么，而是尊重病人的自主权，让他们选择他们想做的治疗方案。另一种做法是医生在不考虑患者的治疗目标或不让患者参与决策过程的情况下做出健康决定，这是非常不道德的，并且违背了个人自主和自由的理念。
- 医生优势
医生被认为比病人优越的原因是，医师倾向于使用大胆的措辞和概念将他或她置于患者上方的位置。医患关系也因患者的痛苦（患者源于拉丁语“饱受痛苦”），和自己缓解疾病的能力有限而变得复杂，从而可能导致绝望和对医师的依赖。医生应该意识到这些差异，以便建立良好的融洽关系并优化与患者的沟通。此外，对这些差异有一个清晰的认识可以在很大程度上帮助患者在未来的治疗。对医患关系而言，拥有一种与患者共同授权的某种形式的医疗服务，以对其治疗护理承担更大程度的责任，可能会更为有益。
那些去看医生的人通常不知道他们为什么在那里的确切的医学原因，这就是他们首先去看医生的原因。对于一个病人来说，因为他们不能理解实验室检查的结果，或是因为他们的医生没有和他们解释，所以可能不能理解他们的身体状况，是一个令人恐惧、沮丧的情况。
- 医生偏见
医生往往高估他们的沟通技巧，以及他们为病人提供的信息量。例如，对700名外科医生和807名病人进行的广泛研究发现，75%的外科医生认为他们与病人的沟通令人满意，然而，实际只有21%的患者对他们的交流感到满意。医生也很有可能低估病人的信息需求和欲望，尤其是对于那些没有大学学历或经济状况不佳的患者而言。无处不在的证据表明，患者的个人属性（例如年龄，性别和社会经济地位）可能会对其产生影响。受过更好教育的患者以及来自上层或上层中产阶级的患者，通常从医生那里获得的信息质量和数量都高于社会阶层另一端的患者，尽管双方对信息的需求是相同的。
- 患者受益或心情愉悦的选择
由于多种原因，在确定最有效的治疗或避免治疗的情况下，医师与患者之间会产生分歧时，可能会出现两难的情况。在这种情况下，医生需要以最小化医患关系的方式呈现不利治疗方案或不受欢迎信息的策略，同时有益于患者的整体身体健康和最佳利益。当病人不愿做医生专业素养所判断出的正确的治疗过程时，病人就变得不依从。要积极加强不愉快的选择，对医生坚持培训就变得很有必要。
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