Healthcare Ethics are so ubiquitous that these can be regarded as commonsense. These are not just for distinguishing between right and wrong but have more implications. To determine, if these are being followed, these need to be codified.  

It is recognised that all Professionals, especially in Healthcare Services, follow the prevailing Ethics but interpret and apply them in different ways in light of their own values and life experiences.  

In Healthcare Services, following World War II, rapid developments in Healthcare Technology have complicated many Healthcare issues and questioned core Ethical Principles.  

Ethical decision-making for patient care has become a complex process. Therefore most of the Countries have Ethical Regulations, which can be enforced as Laws. 

The following is a brief discussion of Core Ethical Principles, derived from ancient and current philosophies, which are practiced as Medical Ethics as well as Ethical Regulations. It is recommended that Medical Ethics must be evaluated frequently to ensure that these are well-founded and adequately handle the current developments in Healthcare Technology.  

The main Ethical Principle is that Physicians will prioritize the patient’s needs and well-being above all else. It is now required that in addition to Patient Rights, Patient duty to protect Healthcare Professionals must also be prescribed. 

Two Healthcare Ethics from the Hippocratic Code of Ethics, listed as under, always form part of any Code of Ethics, and are practiced. 

1. Beneficence 
   • Act in the best interests of the patient, maximizing benefits and minimizing potential harms.  
   • It also includes that Healthcare Provider should present all the possible treatment options, that are available. 
2. Non-maleficence 
   • Nonmaleficence is a guiding principle which requires careful consideration of all proposed actions to ensure that no harm comes to the Patient by these actions. 
   • It dictates “Avoid harm to the Patient” by your actions.  
   • It requires a comprehensive evaluation of the proposed action. For example, giving an injection will cause pain which is acceptable but there is a risk of causing infection at the same time, which must be evaluated. This principle requires evaluating the “Risk and Benefit Analysis” and then take the decision. 
   • Certain risks may be necessary and be taken, to perform necessary medical tasks and benefit the patient eventually.

OTHER HEALTHCARE ETHICS AS PRACTICED NOW ARE AS UNDER 

1. Justice 
   • Justice is a nuanced principle that means treating all patients equally and fairly. It means that patients should not be denied care, have restricted access to care, or be provided with lower-quality of care, based on their economic class, ethnicity, gender identity and expression, or any other characteristic. 
   • The principle of Justice does not necessarily mean equal care but rather equitable care. It requires provision of minimal life sustaining care at all times. When a Health facility is too full and cannot accept more patients, it must move the patient to an alternate facility with adequate Medical Supervision. 
   • Justice also applies to emergency situations. When there are many patients seeking care in a facility with limited resources, it allows Healthcare Professionals to gauge the severity of patients’ conditions and determine the order in which each Patient will receives the care (Also called Triage). 
   • Justice also applies to emergency situations when critical supplies available are very limited and Healthcare Professionals  may need to choose which patients receive the life-sustaining care or get to use some scarce Medical Equipment. The decision making in such situations should be on the principles of Natural Justice that ensures commonly perceived fairness and impartiality of the decision made. 
2. Autonomy 
   • It is defined as the right of an individual to make their own decisions about their Body and Health, free from coercion or violence. It is a fundamental Human Right that applies to all individuals, regardless of gender.  
   • It includes the freedom to choose or refuse Medical Treatment. 
   • It includes the right to make all decisions about one’s own body, sexuality, and reproductive life.  
   • It includes Individual’s right to provide “Informed Consent” for Medical Procedures, Hospital Admissions and Organ Transplantation – as Donor or as Receiver.  
   • Patient autonomy allows Healthcare Professionals to educate the Patient but does not empower them to make decisions on their behalf (except in emergency situations and other defined medico-legal situations). Even when the professional believes a specific treatment is in the patient’s best interest, autonomy allows the patient to have the final say in the decision-making process.  
   • If the patient is of sound mind, capable of making their own choices, Medical Treatment should not begin until the Patient provides informed permission. 
   • If there is conflict in Healthcare Professionals opinion and patient decision, or if there is conflict with other edicts to always attempt to help patients, ultimately the patients’ wishes take priority. 
   • It also includes the duty of the Healthcare Professionals to disclose the information related to the Prognosis to the Patient. The Principle of Autonomy allows the Patient to authorize a family member or members to make decisions for him/her. When this right has been exercised, the Healthcare Professionals can disclose the information related to the Prognosis of the Patient to the family. 
3. Confidentiality 
   • Healthcare Professionals will maintain confidentiality with respect to their Patients’ Health Information. They shall not disclose confidential information given by a patient to another party, including Patient’s family, Patient’s Spouse, etc., without the patient’s authorization. 
   • An exception is the sharing of necessary medical information for the care of the patient from the primary physician to consultants and other health-care teams. This is covered as implied patient authorization. 
   • Another exception is the sharing of medical information in case of Children with their parents or Legal Guardians. This is legal authorization. 
   • Another exception is the sharing of Medical Information in Medico-legal cases. This is legal authorization. 
4. Integrity and Skill 
   • Healthcare Professionals will always contribute to improve the Public Health. 
   • Healthcare Professionals are expected to be honest in their practice and accept patients in accordance with their knowledge and skills. They shall provide Medical Care with respect for Human Dignity and with respect for Patient Rights. 
   • Healthcare Professionals are expected to uphold the standards of professionalism in their interactions with Patients avoid fraud or deception. Standards of Professionalism are prescribed by Professional Associations or Councils of various Healthcare Providers. 
   • Healthcare Professionals will make continuous efforts to improve their skills, acquire advance scientific knowledge and attend Continuing Medical Education events. They shall use the talents of other Health Professionals. They shall obtain and provide “Cross Consultations, when required. 
5. Soliciting Patients  
   • Practice of Medicine is an imperfect science. Therefore, all Countries have Ethical and Codal regulations that prohibits soliciting patients directly or indirectly by Healthcare Providers or by Organisations employing Healthcare Providers. The Healthcare Providers or Organisations employing Healthcare Providers cannot make any public claims (or guarantees) for curing a disease. 
   • The Healthcare Providers or Organisations employing Healthcare Providers are legally required to provide Emergency and Urgent care, in good faith, and even without consent of the Patient. Continuation of the care provided is exempted from the ambit of Soliciting Patients. 
   • The Healthcare Providers or Organisations employing Healthcare Providers cannot permit his/her/their name to be used for endorsement of drugs, medical devices, clinical trials, etc. 
   • Some limited, informational advertising is allowed, and this is usually regulated by Country specific Ethical Regulations. 

Healthcare Ethics are inseparable from Clinical Medicine as they help Physicians to make Clinical Decisions for Patient Care. These decisions are not just right treatments or interventions but are appropriate for the particular patient, his/her family, and conforming to their cultural and religious beliefs. National Health Policy must specify Healthcare Ethics to improve the Patient Trust in the Healthcare System.