There’s no scarcity of legal and ethical issues in medicine. Gaining a handle on ethical issues in neurology requires a combination of interactive discussions with other professionals, reflecting on personal experience and formal instruction.
Often, there may not be an obvious or clear answer when we’re deciding which ethical principle should prevail. But as physicians, we can all learn from shared experiences and the work of others. We can also come up with consistent rules for what decisions are best and develop tools for dealing with the emotionally charged aspects of patient care.
Dr. Thomas Cochrane’s lecture “Ethical and Legal Issues in Neurologic Practice,” now available for CME credit through AudioDigest, is a useful aid for understanding ethical dilemmas in patient care and a great way to learn strategies for when these quandaries arise.
The Difference Between Ethics and Law
While we often associate ethics with “doing the right thing,” they also overlap with issues of legality. Dr. Cochrane makes an important distinction between ethics and law, suggesting that doctors work out the ethics of a given situation first and then figure out the law that applies to the situation. This way, both law and ethics are fully recognized.
Dr. Cochrane discusses the example of organ donation and brain death — one of the most commonly debated ethical issues in neurology — in terms of the ethics and the law. The relationship between organ donation and brain death is subject to clear legal guidelines, but the ethics are muddier because families are often distraught if their loved one wanted to donate their organs, even when they have a clear understanding of their loved one’s wishes.
The law in this type of situation accounts for time for families to experience their much-needed goodbyes when they’re in the midst of acknowledging and balancing the reality of death with the impending donation procedure.
The Principles of Medical Ethics
Dr. Cochrane also provides a helpful overview of the components of medical ethics, including some helpful mnemonics for those who need to know these concepts for board exams. The four pillars he discusses are:
- Respect for autonomy
Dr. Cochrane puts special emphasis on autonomy. Autonomy means respecting a patient’s role in their medical care and includes nuances related to patient competence, disclosure of information, patient comprehension and voluntariness. Autonomy is the most complicated of the four components of ethics because it can be hard to know how much a patient understands, especially when a patient’s communication is impaired by neurological or other disease.
Beneficence is the principle of doing good for patients, while nonmaleficence means not doing harm, a concept that involves balancing risk and benefit. Justice is about equitable distribution of resources. None of these concepts is simple or straightforward, and as a physician, you may find yourself wavering as you deliberate the best way to move forward.
Dr. Cochrane discusses several legal issues, including the different types of advanced directives and when each should be used. His presentation includes several definitions and distinctions between the categories as well as advice about how doctors can encourage patients and families to formally document their wishes in advance.
Dr. Cochrane also suggests that doctors familiarize themselves with state-specific regulations regarding issues like organ donation and emergency consent. Physicians should also seek advice from legal counsel when issues arise that could lead to trouble or that could be interpreted in different ways.
Legal and ethical issues in medicine surface early in a physician’s medical education. For example, hypothetical patient cases are often brought up in small group discussions. This gives a student the opportunity to consider possible future scenarios.
The subject of medical ethics is revisited as theory is put into practice, and all doctors need to acknowledge that the cycle of facing practical dilemmas in patient care and turning toward focused learning will be repeated as ethical issues continue to arise throughout a physician’s career. “Ethical and Legal Issues in Neurologic Practice” can be a useful introduction or an opportunity to revisit these foundations and consider how they apply to medical practice.