Physician Beneficence Research Articles

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Physician beneficence and profit-taking among private for-profit clinics in China: A field study using a mystery shopper audit

This study employs a mystery shopper audit on a random sample of 96 for-profit private clinics in Jinan, China. We investigate two instruments which reflect beneficence among for-profit clinicians in private practice. The first is whether physicians returned a lost wallet “accidentally” left next to the physician’s table; and the second, whether physicians prescribed antibiotics to pseudo-patients who displayed no symptoms of any illness but had complained of fever the night before. These measures quantify beneficence under two different valence framing: returning a wallet represents clinicians who “do good” at personal cost to themselves, while not prescribing antibiotics represents a choice “not to do harm” to patients. We look at the correlation between these beneficence measures and the physicians’ prescription behaviors, and their revenues from the consultation. We find that whether doctors return a lost wallet or not, and prescribe antibiotics or not, such physicians are still as likely to prescribe medications which increase their incomes.

Ethics of Resident Involvement in Surgical Training.

After IRB approval, surgeons from three institutions were invited to participate in a pilot, survey, exploring how principles of patient autonomy, physician beneficence, nonmaleficence, and justice apply to participant opinions. Responses were transcribed and coded for quantitative and qualitative analysis. 51 attendings and 55 residents completed the survey. We identified that patient autonomy is upheld through transparent consent practices. Intraoperative supervision is a key practice that maintains the principles of physician beneficence and nonmaleficence and mitigates the risk of resident participation. Vulnerable patients were defined by respondents as those unable to participate in their own consent and those limited by social determinants of health and barriers to medical literacy. In contrast, resident participation is not limited in the care of vulnerable patients but is restricted in cases of higher complexity and those procedures deemed to have lower error margins. Although residents measure the success of their training based on their level of intraoperative independence, autonomy afforded to the resident does not only depend on objective skill. There are ethical considerations that the attending must navigate as they decide on effective teaching and safe surgical management, which is especially relevant in the care of complex cases.

Ethics of Resident Involvement in Surgical Training

INTRODUCTION: An attending surgeon must maintain a balance between allowing appropriate resident independence while ensuring safe medical management of the patient. This pilot investigation aims to characterize these conflicts within an ethical framework by qualitative analysis of opinions of active teaching physicians and residents in the field. We hypothesize that the ethical principles of patient autonomy, physician beneficence, and justice/equal opportunity can be applied to organizing the themes and opinions that will be provided by study participants. METHODS: After IRB approval, attending physicians and residents from 3 Accreditation Council for Graduate Medical Education–approved institutions were invited to participate in our pilot study. Participation involves completion of an anonymous, peer-revised online survey, structured to characterize the ethical foundations of surgical teaching from the perspective of both teachers and trainees. The survey answers and general demographics are transcribed and coded for quantitative and qualitative analysis. RESULTS: This study is currently ongoing. In preliminary findings, we have identified particular reluctance in providing autonomy to residents when caring for vulnerable populations (ie children, oncology). The importance of disclosure and informed consent has also been a recurring theme. CONCLUSION: Although surgical residents may measure the success of their training on their level of intraoperative independence, we have identified that intraoperative autonomy afforded to the resident does not only depend on their objective skill or experience. There are complex ethical considerations that the attending surgeon must navigate as they decide on appropriate, effective teaching and safe surgical management, which is especially relevant when vulnerable patient populations are involved.

Prudence in Shared Decision-Making: The Missing Link between the "Technically Correct" and the "Morally Good" in Medical Decision-Making.

Shared Decision-Making is a widely accepted model of the physician-patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise-complementary in nature, equal in importance-is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma's proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

Ethical issues in the evaluation of adults with suspected genetic neuromuscular disorders.

Genetic testing is rapidly becoming an increasingly significant part of the diagnostic armamentarium of neuromuscular clinicians. Although technically easy to order, the results of such testing, whether positive or negative, have potentially enormous consequences for the individual tested and for family members. As a result, ethical considerations must be in the forefront of the physician's agenda when obtaining genetic testing. Informed consent is an important starting point for discussions between physicians and patients, but the counseling embedded in the informed consent process must be an ongoing part of subsequent interactions, including return of results and follow-up. Patient autonomy, including the right to know and right not-to-know results, must be respected. Considerations of capacity, physician beneficence and nonmaleficence, and privacy all play roles in the process. Muscle Nerve 54: 997-1006, 2016.

Challenges to ethics and professionalism facing the contemporary neurologist.

Challenges to ethics and professionalism that can harm neurologists and their patients include the commercialization of medicine, poorly designed Medicare regulations, conflicts of interest, physician employment by hospitals, faulty measurement of medical quality care, electronic health records, electronic communications with patients, and the demotion of the role of physician beneficence. These threats can lead to inaccurate medical record-keeping, unnecessary medical care, a decline in the primacy of patients' interests, and damage to the sanctity of the patient-physician relationship. The increasing frequency of physician burnout can be attributed at least partially to unmitigated stresses on practicing physicians, particularly the growing time pressures for patient visits, the mounting daily requirements of documentation, and the increasing burden of time-consuming but unproductive tasks. Recommended correctives include reforming billing documentation regulations, improving electronic health records, designing proper quality indicators integrating physician wellness, and incorporating reasonable physician workflows in the design of accountable care organizations.

Ethical dilemmas in decision making at limits of neonatal viability

The survival rate for extremely preterm infants has improved over the last two decades. Although the incidence of such births is about 2%, the impact of preterm birth on these infants, their families, health-care providers, and society is profound. The birth of an extremely low birth weight (ELBW) and early gestational age infant poses complex medical, social, and ethical challenges to the family and health-care professionals. Survivors have an increased risk of chronic medical problems and disability. It is difficult to make decisions while trying to provide optimal medical care to the infant and supporting the family when delivery occurs at the threshold of viability because outcome at that time is highly unpredictable. Such decisions may have lifelong consequences for those involved.An individualized prognostic strategy appears to be the most appropriate approach. While keeping the patient’s best interest as the primary objective, the goal is to reach, through a process of effective communication between the parents and physicians, a consensual decision that respects the parents’ wishes and promotes physician beneficence.

From ‘directing them’ to ‘it's up to them’: The physician's perceived professional role in the physician−patient relationship

One of the oldest goals of the medical profession is to benefit, and do no harm to, the patient. The role of the physician was once a paternal one, with total physician control, and little value given to patient knowledge of their own illness experiences. With changing patient expectations and medical education reform, patient-centeredness has emerged as a dominant ideal in doctor–patient communication. Patient autonomy is increasingly valued. In this changing time of increased patient involvement in medical decision making, how do physicians describe their professional roles/identities? Self-described professional identity is often quite reflective of professional beliefs and practice. The present study offers a qualitative perspective on self-perceived physician professional roles from primary care physicians of three age groups, in their 50s, 40s, and 30s. Younger physicians in the sample expect patients to have the most autonomy and most control over their decision making, while older physicians still expect to have the most control. It is possible that these age-based patterns of physician professional identity reflect an increasingly autonomous patient role and a decreasing role for physician beneficence. Implications and practical applications of these results for the medical interview will be discussed.

The Virtuous Psychiatrist: Character Ethics in Psychiatric Practiceby RaddenJennifer and SadlerJohn Z. New York, Oxford University Press, 2010, 256pp., $49.95.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessThe Virtuous Psychiatrist: Character Ethics in Psychiatric PracticeSpencer Eth, M.D.Spencer EthSearch for more papers by this author, M.D.Published Online:1 Nov 2010https://doi.org/10.1176/appi.ajp.2010.10081185AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by RaddenJennifer and SadlerJohn Z.New York, Oxford University Press, 2010, 256pp., $49.95.For a painfully long time, psychiatrists have been vilified in the media for everything from minor transgressions to egregious violations of our professional standards, most notably in the sexual misconduct scandals of the late twentieth century and more recently in the allegations of direct involvement in torturing enemy combatants during secret interrogations. Studies have surveyed lapses in medical ethics and found them committed in a variety of contexts, including among practitioners who are narcissistic, lonely, substance abusing, greedy, or even naive. The American Psychiatric Association has responded by promoting ethics education for its members, revising its procedures for complaint adjudication, and embarking on a major revision of its code. Given this attention to psychiatric ethics, what does this particular book add to the literature and would the Journal audience benefit from a close read?The authors, an academic philosopher (Radden) and psychiatrist (Sadler), boldly assert their foundational belief that “the emphasis on character and moral psychology in a virtue theory significantly augments our understanding of the ethical demands of psychiatric practice” (p. 3). Their position contrasts sharply with the traditional framework for psychiatric ethics that relies on adherence to the duties of the role of physician and to the rules of professional behavior. Medicine has long justified its special place in society by its altruistic goal of striving to achieve positive consequences for patients. Ethical analyses have accordingly explored the core values of patient autonomy and rights, physician beneficence and nonmale?cence (doing good and not causing harm), and justice. The focus of ethical investigations has been on the actions of physicians toward patients with regard to inappropriate conduct that could result in sanctions after a complaint has been filed.Radden and Sadler endorse a radically different approach that starts with the moral character (virtues) of psychiatrists rather than with their behavior. They believe that virtues can be cultivated and character traits altered, especially in training programs with good role models and by habituation. Further, salient factors, such as gender, race, class, and ethnicity, are seen as inescapably tied to self-identity (characterization). In this construct, effective clinicians are those who are morally good. The authors do not offer a practical means to measure virtue apart from behavior. Further, I have difficulty imagining how an ethics hearing panel can successfully assess an accused psychiatrist's character or moral health, especially since the patient's complaint may pertain to one specific action, such as a boundary crossing, which itself is hard to establish given that so much psychiatric care occurs in a closed room with only the psychiatrist and patient present. Surely we would not welcome our ethics committee colleagues probing the internal psychological processes of our members (beware of the nonvirtuous unconscious).The authors are talented writers who can inspire virtue in its many manifestations (trustworthiness, propriety, empathy, warmth, and respect). They occasionally infuse jargon (phronesis, aretaic, supererogatory, and unsel?ng), and to my eye their gender-sensitive ethics for psychiatrists seems to evince a sociopolitical agenda that may undermine therapeutic neutrality. At the risk of quibbling, I would have preferred consideration of the many recent contributions of Paul Appelbaum and Laura Roberts, who are leading authorities in psychiatric ethics, rather than a vague reference to the 1995 Comprehensive Textbook of Psychiatry. As a future project, Radden and Sadler could expand their scope and explore the virtuous professional organization (i.e., Should the Association accept pharmaceutical advertising in its journals?) and the virtuous medical center (i.e., Should the hospital deliver charity care in the face of deficits?).The final chapter presents case studies that reassuringly find psychiatric virtues in practitioners, trainees, and supervisors during the course of their ordinary clinical work. One may wonder which occurred first, good virtue or good behavior, or perhaps these psychiatrists were inherently virtuous without self-awareness, much as Moliere's character was delighted to learn that he had been speaking prose all his life without knowing it. Even so, this is an ambitious and provocative text whose thesis deserves the consideration of our field.Miami, Fla.Book review accepted for publication August 2010The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 167Issue 11 November 2010Pages 1411-1412 Metrics PDF download History Accepted 1 August 2010 Published online 1 November 2010 Published in print 1 November 2010

Patient autonomy and the ethics of responsibility

The principle of patient autonomy dominates the contemporary debate over medical ethics. In this examination of the doctor-patient relationship, physician and philosopher Alfred Tauber argues that the idea of patient autonomy -- which was inspired by other rights-based movements of the 1960s -- was an extrapolation from political and social philosophy that fails to ground medicine's moral philosophy. He proposes instead a reconfiguration of personal autonomy and a renewed commitment to an ethics of care. In this formulation, physician beneficence and responsibility become powerful means for supporting the autonomy and dignity of patients. Beneficence, Tauber argues, should not be confused with the medical paternalism that fueled the patient rights movement. Rather, beneficence and responsibility are moral principles that not only are compatible with patient autonomy but strengthen it. Coordinating the rights of patients with the responsibilities of their caregivers will result in a more humane and robust medicine.Tauber examines the historical and philosophical competition between facts (scientific objectivity) and values (patient care) in medicine. He analyzes the shifting conceptions of personhood underlying the doctor-patient relationship, offers a topology of autonomy, from Locke and Kant to Hume and Mill, and explores both philosophical and practical strategies for reconfiguring trust and autonomy. Framing the practicalities of the clinical encounter with moral reflections, Tauber calls for an ethical medicine in which facts and values are integrated and humane values are deliberately included in the program of care.

Sick autonomy.

Complex social and economic forces have placed patient autonomy at the center of medical ethics, and thereby displaced an older ethic of physician beneficence. This development arose, and is sustained, by waning trust in the traditional doctor-patient relationship. As patients have increasingly become clients and consumers, a contract basis for medical care has put the ancient covenant of care in jeopardy. Here, a philosophical approach to harmonize the apparent conflicting claims of patient autonomy and physician beneficence is offered by demonstrating that autonomy need not be understood as protecting a threatened identity. If persons are regarded as atomistic, certain defensive notions of individualistic rights-based autonomy prevail; if a relational construction of personal identity is employed instead, then respect for autonomy becomes part of a wider morality of relationship and care. By reconfiguring trust within this latter understanding of personhood, bioethics better balances its concerns over choices and actions with those of relationship and responsibility. Neither atomistic autonomy nor the ethics of responsibility can claim hegemony, for they are mutually interdependent, and a complete account of medicine's moral axis requires that they be integrated. This reorientation is crucial for reasserting the ethos of clinical medicine, whose fundamental mandate remains the care of others.

Perinatal Care at the Threshold of Viability—From Principles to Practice

The threatened birth of an extremely-low-birth-weight (ELBW) and gestational age infant presents complex medical, social and ethical issues for the family and the health professionals. Improved survival may be accompanied by increased risks of chronic medical problems and neurodevelopmental disabilities. It is difficult to define “how small is too small” and to decide “how much is too much” in providing optimal management of the mother and infant when delivery takes place at the threshold of viability. An individualised prognostic strategy appears to be the most appropriate approach. Through a process of communication and value exploration between the well-meaning parents and well-intentioned physicians, the goal is to reach a consensual decision that respects parental authority and promotes physician beneficence, with the best interests of the infant placed in the centre of the analysis.

Informed consent as a tool for medical management: a review of Informed Consent: Patient Autonomy and Physician Beneficence Within Clinical Medicine by Stephen Wear.

Journal Article Informed Consent as a Tool for Medical Management Get access Stephen Wear, Informed Consent: Patient Autonomy and Physician Beneficence Within Clinical Medicine 1993: Kluwer Academic Publishers, Dordrecht. B. Andrew Lustig, Ph.D. B. Andrew Lustig, Ph.D. Institute of Religion, Baylor College of MedicineHouston, Texas, U.S.A. Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, Volume 21, Issue 1, February 1996, Pages 101–109, https://doi.org/10.1093/jmp/21.1.101 Published: 01 February 1996

BOOK REVIEWS

Book Reviews in this Article: Accountability of Bioethics Committees and Consultants by Sigrid Fry Revere. Research Ethics in Practice: The Animal Ethics Committees in Sweden, The Beginning of Human Life edited by Fritz K. Beller and Robert F. Weir. Dordecht Dementia und Aging: Ethics, Values, ad Policy Choices, edited by Robert H. Binstock, Stephen G. Post and Peter J. White‐house. Least Worst Death—Essays in Bioethics on the End of Life by Margaret Pabst Battin. All God's Mistakes—Genetic Counseling in a Pediatric Hospital by Charles L. Bosk. Informed Consent: Patient Autonomy and Physician Beneficence within Clinical Medicine by Stephen Wear.

Ethical Issues in Pediatric Consultation-Liaison

General principles of medical ethics are outlined as a basis for discussion of ethical issues in pediatric consultation-liaison psychiatry. Modern ethics is rooted in philosophical soils that extend across a wide intellectual terrain, from ideologic ethical systems such as rule utilitarianism and act utilitarianism to deontologic systems, exemplified by the categoric imperative. Differences between the conclusions pointed to by these systems give rise to the potential tensions among concepts of patient autonomy, physician beneficence, and distributive justice. The roles of the child psychiatrist consulting to pediatrics are reviewed. Using six clinical vignettes, several ethical issues and the child psychiatrist‘s response to them are explored. These are analyzed in relation to the underlying ethical theory.

Informed consent. Patient autonomy and physician beneficence within clinical medicine

Informed consent. Patient autonomy and physician beneficence within clinical medicine

Informed consent: Patient autonomy and physician beneficence within clinical medicine

Informed consent: Patient autonomy and physician beneficence within clinical medicine

Just doctoring: medical ethics in the liberal state

Just Doctoring draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problemsfrom informed consent to care rationing and the repercussions of the HIV epidemicand gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century.

Medicine and money: a study of the role of beneficence in health care cost containment

Preface Beneficence as the Foundation for the Health Care System Defining the Problem Cost Containment's Threat to Health Care The Justification of a Health Policy Based on Rights and Justice Justifying a Beneficence Based Health Care System Implementing Beneficence in the Health Care System Beneficence and the Role of the Physician Beneficence and the Neonatologist Beneficence and the Treatment of the Elderly Beneficence and the Difficult Patient Bibliography Index