Ethics in healthcare
Thank God doctors are excellently trained to save lives. But there may come a point when what they do no longer helps. Should they continue trying to cure a patient who has practically no more hope for recovery, or give up and “pull the plug”?
Healthcare professionals encounter many other dilemmas. Take the case of a husband with a sexually transmitted disease. Should a doctor keep such information confidential, or should he inform the healthy wife, who has the right not to get infected? What should a neurologist who diagnoses a bus driver with epilepsy do?
A woman brought to the emergency room needs a blood transfusion. The husband refuses because his religion prohibits it, but the wife’s religion allows it. What is to be done?
Perhaps in these cases, doctors will know what to do in their respective fields. Still, they will have to make difficult decisions beyond what is, strictly speaking, medical. Sometimes they will have to tread into the intimacy of a patient’s family life or deal with hospital or government policies, and with their peers.
We can just imagine how much more difficult these situations are for patients and their families. They are the most affected, not only in struggling for a cure, but also in paying the costs and in bearing all the emotional burdens these entail. They need to take time off from work or study to accompany a loved one, reorganizing not only their usual activities but their life goals as well.
When difficult situations arise, hospital administrators cannot but get involved. Clients or staff members might complain. Courts or government agencies require certain courses of action. Insurance and other companies make their demands. Even society as a whole can get involved, including the media, lawmakers, businesses, etc.
So there. Medicine is not simply a science of prescribing medicines or procedures to cure the sick. It is much more than the art of fine-tuning general medical principles to the specific needs of a patient. Healthcare involves the sick, the healer, and the community. Better healthcare requires much more than improving medicines and machines.
This is bioethics — also known as medical ethics, biomedical ethics, or healthcare ethics. It reflects on what can be offered and what will be best to do, taking into account a patient’s situation, available medical care and practitioners, and the community, which in turn includes the family, other patients, and society as a whole. As a field of study, it often tries to incorporate three angles: ethical (aiming for the good), medical (aiming for a cure) and legal (aiming for justice). These angles immediately become evident when one reflects on caring for a patient with no hope for recovery while the family’s and society’s resources are being depleted, confidentiality, peer relationships, and acting as a proxy. What course of action is good, that would effect a cure if possible, and is just for all?
Bioethics is the search, through dialogue and reflection on some basic principles, for the best for patients, their families, healthcare providers, and society as a whole. Its first role is in continuing education. The more doctors and other healthcare workers, hospital administrators, and families study bioethics, the easier it will be for them to make difficult decisions. Its second role is to help formulate guidelines, policies and standard procedures, to assist the patient, family and doctors in decision-making. Its third role is to provide suggestions and considerations, through a bioethics committee, and to inform a patient of any policies or laws that have to be followed—for the patient to eventually decide.
Bioethics tries to make life easier for all, in caring for our health and that of others. We need to have a personal view on certain situations, but would it not also help to see what others think, especially those who have been there, done that? We learn from mistakes and successes, not only ours but also others’.
With bioethics, doctors can serve in their noble profession even better. Easier and better decision-making for all, streamlined operations, avoiding misunderstandings and lawsuits, minimizing extraordinary procedures and medicines that do not give hope for recovery, more rational allocation of scarce resources—in short, healthier patients and relationships: This is what bioethics is all about.
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Fr. Gregory Ramon D. Gaston is rector of the Pontificio Collegio Filippino in Rome, where Filipino priests do further studies. He studied for two years at the UP College of Medicine before entering the priesthood, and eventually obtained a doctorate in sacred theology, taught bioethics, and sat in bioethics committees. He will lead an online Lenten Reflection on sickness and healing at noon on the first four Fridays of March (visit pcfroma.org for Cardinal Luis Antonio Tagle’s video invitation, and to participate for free).
