Clinical Ethics
What Is Clinical Ethics?
Clinical ethics is part of the broader discipline of bioethics. It is a structured approach to ethical decision-making in medicine and is used to help guide choices about medical care.
Bioethics is the interdisciplinary study of ethical issues arising in the life sciences, health care, and health and science policy.
Clinical ethics can help to identify, understand and resolve ethical issues that arise in patient care by helping to clarify why certain actions are right or wrong. Clinical ethics uses ethical reasoning and the application of bioethical principles to resolve ethics questions.
The Core Principles of Bioethics
- Beneficence: duty to help the patient advance their own good and to act in a patient’s best interest
- Autonomy: duty to honor a patients right to make their own decision and to be self-determining
- Nonmaleficence: duty to do no harm to the patient
- Justice: duty to be fair in how care is provided and in how resources are allocated
No single principle trumps the others; their relationship is dynamic and requires clinicians to carefully evaluate each situation on its own merits and patient needs.
The Difference between Morals and Ethics
These terms are often used interchangeably to refer to what is considered right or wrong. But they are not exactly the same.
- Morals refers to generally accepted customs or practices that are based on common societal values and beliefs
- Ethics focuses on deliberation and explicit arguments to justify why actions are right or wrong
An Approach to Resolving Ethics Questions
Uncertainty is an inherent part of clinical medicine because there are often multiple courses of action available—each with its own set of risks, benefits and burdens. Clinical ethics is rarely just about figuring out if something is right or wrong. Rather, it involves a deliberative process to figure out a better, more right, more reasonable, or possibly least bad option.
To resolve an ethics question that arises in the course of caring for a patient it is important to:
- Identify the problem or dilemma
- Understand the medical facts and available diagnostic and treatment options
- Understand the concerns of the clinician and/or medical team
- Understand the preference of the patient and their goals, values and priorities
- Understand how the various options will impact the quality of life of the patient
- Understand any contextual features relevant to the situation (laws, regulations, etc.)
- Identify the ethical principles that are in conflict
- Identify any practical considerations that need to be addressed
References & Resources
- Beauchamp TL, Childress JF. Principles of Biomedical Ethics. Sixth Edition. Oxford University Press (2009)
- Jonsen AR, Seigler M, Winslade WJ. Clinical Ethics: A practical approach to ethical decisions in Clinical Medicine. Ninth Edition. McGraw Hill (2022)
- Lo B. Resolving Ethical Dilemmas: A guide for clinicians. Fifth Edition. Lippincott Williams & Wilkins (2013)
- Snyder Sulmasy L, Bledsoe TA. ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians Ethics Manual. Seventh Edition. Ann Intern Med. 2019;170:S1-32.
- The Hastings Center. (2022, August 10). What is Bioethics? https://www.thehastingscenter.org/what-is-bioethics/
