How do we best support patients as they near the end of their lives? How should physicians assess the risks and benefits of implementing a brand-new medical device in their practice? Is it ethical for hospitals to mandate COVID-19 vaccines for their health care workers?
In medicine, very little is black and white.
Bioethics is a broad field that encompasses the various philosophical, social and legal dilemmas in the realms of medicine and life sciences. Classically, when students progress through their medical education, they are taught to think critically — taking a set of signs and symptoms and piecing together a differential diagnosis, assessment and treatment plan. However, in the quest to treat patients with the best level of care, it is important for students to be exposed to times when patient care is not so simple.
Students enter medical school with a wide variety of experiences that can drive the way they think about medical problems. My introduction to ethics was, in fact, not in the realm of bioethics itself, but as an extension of my undergraduate journalism involvement. As an editor for my college newspaper for three and a half years, I took classes out of interest in the Journalism department of my school, the first being journalistic ethics. In this course I learned the Society of Professional Journalism’s four principles in ethical reporting: seek the truth and report it, minimize harm, act independently and be accountable and transparent.
Now, as a medical student who has begun to experience ethical dilemmas in the realm of patient care, I’ve discovered that the ethics of journalists and physicians are more similar than I expected.
Seek the truth and report it: Physicians act as detectives, collecting the clues of a patient’s case to discover the underlying cause of their medical problem. Along the way, it is critical for physicians to be in communication with their patients. Such communication fosters rapport and a collaborative environment which assures the patient that they are a part of their health care team. There are, however, times when the truth is difficult to report.
Delivering news of a mild middle ear infection is much more comfortable than informing a patient of a terminal illness. Thus, tools to aid physicians in communication, such as the SPIKES six-step protocol for delivering bad news, were created. While delivering life-altering diagnoses to patients will never be easy, such tools can help the physician deliver news in a way that gives patients more control of the next phase of their care.
Minimize harm: The four most common principles of medical ethics are autonomy, beneficence, non-maleficence and justice. Beneficence and non-maleficence fall into this category very neatly: physicians are expected to try their best to diagnose and treat their patients comprehensively. Notably, however, minimizing harm also encompasses the practice of advocacy.
For example, we can systematically improve patient care by supporting and advocating for policy changes at the governmental level, thus minimizing harm to patients. By providing care at Community Health Centers, physicians can ensure that those individuals who historically may not have had access to high quality care are now able to do so. Minimizing harm involves many facets of patient care and is therefore incredibly relevant to the practicing physician.
Act independently: Physicians, as human beings, participate in activities outside of medicine — teaching, research, inventing, etc. Such non-clinical activities can lead to relationships with outside organizations, businesses and people, sometimes involving financial incentives. For a physician, this means that not all choices may be independent of outside influence.
Gifts from drug companies, for instance, may encourage a physician to prescribe one brand of drug less suitable for a patient’s needs, therefore conceding optimal care. That said, the AMA Council on Ethics and Judicial Affairs has put forward guidelines about which gifts are and are not acceptable — gifts of minimal value such as pens are acceptable, whereas travel and lodging are not.
Cooperation with outside organizations does not always have bad outcomes, however. In particular, research collaborations may help to improve overall public health, thus affecting the medical care of more than just one’s own patients. For instance, Physician Research Collaboration is an organization that connects corporate sponsors with physicians who need support in conducting clinical trials. Such clinical trials have worked to expand treatment for gout, rheumatoid arthritis and giant cell arteritis, among others. Such discoveries are certainly positive for society, but it remains critical for physicians to be forthcoming of their affiliations as transparency increases objectivity of care.
Be accountable and be transparent: An ongoing discussion in the medical field is the push to improve physician accountability for errors. Studies have shown that medical providers may not always feel comfortable disclosing when a mistake is made, sometimes even obscuring their role in the mistake. To improve accountability and transparency after medical errors, initiatives like the I’m Sorry movement have been developed.
The initiative focuses on disclosing and apologizing for errors, as well as offering compensation for negative outcomes. Furthermore, it aims to improve patient safety while assisting physicians when errors and adverse events take place. Whether it’s fear of embarrassment, legal action or even the termination of one’s career, there are many obstacles to disclosing errors to patients, but physicians have an ethical obligation to be forthright with their patients; transparency is crucial in the practice of patient-centered care.
While this piece focuses on how medical ethics fits into the tenants of journalistic ethics, the fact is that quality journalism similarly upholds the principles of medical ethics. Consider the medical ethics principles of autonomy, justice, beneficence and non-maleficence. The journalist’s responsibility to autonomy is such that they are dedicated solely to the truth that they are reporting, as opposed to outside forces such as their employer or other organizations.
Non-maleficence and beneficence are complex insofar as a journalist seeking the truth may uncover negative parts of a subject’s history or actions and expose them for these wrongdoings while still acting in the public’s interest. As long as the journalist is reporting based on fact and the truth, such damaging reports would not violate ethical principles.
Finally, investigative work often uncovers injustices in our world, thus holding people accountable and acting in the name of justice. Namely, the Boston Globe famously published investigative work in 2002 that uncovered five Roman Catholic priests who sexually assaulted minors in what became better known as the Spotlight Investigation. By bringing light to the widespread crimes that had been taking place, journalists facilitated a platform for victims to come forward and report their abusers, achieving justice by rallying public support.
Of course, it is important to note that both journalistic ethics and medical ethics are far broader than the topics listed above. Each has their own nuances that cannot be captured by simply relaying the overlapping features of the two. However, what remains clear is that the same principles at the heart of journalism — a field that is seemingly so different from medicine on the surface — are actually very similar. These thought processes have come to play as I have stood with patients whose care involves complex ethical questions.
As we progress through medical education, it is important to reflect on all of our personal experiences and life events, as even the seemingly unrelated can inform the way we approach our clinical practice.