Medical Justice is an interdisciplinary field that draws on medical, legal, economic and social science perspectives to examine how healthcare policies and practices create and sustain health disparities and the inequalities that are embedded within the system. It seeks to identify the structural and policy barriers that prevent people from accessing quality healthcare and achieving health equity.
Historically, ethically speaking, doctors have been charged with the duty of beneficence doing good and nonmaleficence not doing harm. However, in certain OR Medical Justice scenarios not only does the doctor have to balance both of these principles, but they also have to take into consideration the principle of autonomy – the right of an individual to make their own decisions. In order to exercise their rights, patients must be able to understand the nature of the treatment being proposed to them, the potential risks and benefits, and alternative treatments, and be free from coercion or undue influence.
This is why informed consent and truth-telling are so important – but it can sometimes be hard for physicians to balance their obligation to protect patient autonomy with their responsibility to provide the best possible care. When this conflict occurs, it is called a “conflict of obligations” and it is not unusual for it to result in a malpractice claim.
To avoid the potential for conflicts of obligation, it is helpful to categorize the different types of physician paternalism that exist: soft, hard and non-paternalism. Soft paternalism views the relationship between a physician and his/her patient as being similar to that of a parent with a child, and it allows physicians to use methods of manipulation or influence consistent with their cultural values and understanding of what is in their patient’s best interest, as long as there is no harm done. This type of paternalism is often associated with non-western cultures.
The other extreme of soft paternalism is consumerism, which is a form of radical patient autonomy in which the physician’s role is limited to providing all medical information and available choices for interventions or treatments while the fully informed patients select what they feel is in their own best interests from the options provided. This model of patient autonomy is viewed by many to be impractical and impossible to implement in real-world clinical practice, because it requires physicians to know exactly what their patients want before they can provide them with the appropriate care.
As a final point, we should not forget the important ethical principle of distributive justice, which requires that scarce public resources be used to benefit as many people as possible. Since healthcare is a publicly funded service, this can be interpreted as the duty of stewards of the public purse to improve population health. This can be accomplished by ensuring that healthcare is cost-effective and delivering the highest net benefit to the population. This is the standard that NICE and the NHS are required to uphold. It is a principle that can help to prevent sham lawsuits that detract from the important work of healthcare providers.
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