Medical Ethics and Health Policy

By Deliana InfanteReviewed by Danielle Ellis, B.Sc.

Introduction
What is medical ethics?
Key principles of medical ethics
What are medical policies?
Key areas of medical policies
Importance of medical ethics and policies
Conclusion 
References 
Further reading

Medical ethics is a pivotal field that provides guidance for the conduct of medical professionals and ensures the integrity of medical practice, protecting the interests of all patients. Misconduct and ethical violations can result in significant disciplinary actions, including the suspension or revocation of a medical license.

Introduction

The Federation of State Medical Boards (FSMB) reports that only 0.5% of US physicians commit serious ethical violations annually, with just 0.1% facing severe disciplinary actions.¹ 

Common violations include sexual abuse of patients (SAP), unnecessary invasive procedures (UIP), and improper prescribing of controlled substances (IPCS).¹ Notably, 3% of physicians account for 62% of opioid prescriptions, highlighting the significant role that a minority plays in the overall distribution of prescription drugs.¹ 

While CDC data shows no increase in opioid-related death rates,² a correlation exists between rising prescriptions and pharmaceutical influence on physicians,^3-4 potentially impacting public trust. 

US data reveals declining public perception of honesty and ethical standards among healthcare professionals.5 Trust varies globally, with China at 94%, the UK at 74%, the US at 62%, Latin America at 45-55%, and Russia at 36%.6 

To reverse this situation, it is key to increase awareness among the general population as well as periodically review medical policies to secure transparency between healthcare providers and patients. 

What is medical ethics?

Medical ethics is an applied branch of ethics that analyzes the practice of clinical medicine and related scientific research.7 It is based on a set of moral values or principles that professionals can refer to in the case of confusion or conflict. These pillars include respect for autonomy, non-maleficence, beneficence, and justice.⁷

The English physician Thomas Percival coined the phrase "medical ethics" in 1803, defining it as a statement of the professional obligations that doctors have to their patients, to their fellow practitioners, and the public.⁸ 

However, the history of medical ethics dates back to the fifth century BCE, with the oaths of Caraka and Hippocrates and other ancient texts that contained basic principles for medical professionals.⁸

The Nuremberg Code (1947), a milestone in ethics history, was created in response to World War II crimes, emphasizing patient consent and autonomy and profoundly influencing human rights law and contemporary medical ethics.8 

In the 1960s-70s, medical ethics evolved into bioethics, first coined by Fritz Jahr in the 1920s.8-9 This led to Institutional Review Boards and ethics committees. Comprehensive ethical norms are now set by The WMA's Code of Medical Ethics.^8,10 

Key principles of medical ethics

There are four pillars of medical ethics, starting with the principle of Beneficence.7 This principle is translated into the practitioners' duty to always act in the patient´s best interest, supporting moral rules that protect others' rights, prevent harm, and help people with disabilities.⁷ 

A corollary to beneficence is the principle of Non-maleficence, expressed by the Hippocrates oath as “do not harm,” which includes not harming the patients, as well as not allowing them to be harmed by inaction.⁷ 

Patients also have the right to make their own decisions about their healthcare. This is assured by the autonomy principle.⁷ Ultimately, the justice principle refers to the requirement to treat all people equally and fairly.⁷ 

What are medical policies?

Medical ethical policies are guidelines that govern the moral conduct of healthcare professionals, ensuring that they uphold ethical standards in their practice.¹¹ 

These policies encompass principles such as patient confidentiality, autonomy, informed consent, and the ethical conduct of research.¹¹ They serve to navigate complex ethical dilemmas in modern medicine, prioritizing patient well-being and ensuring fair and just care.¹¹ 

During the 17th and 18th centuries, the concept of individual autonomy gained prominence, leading to the principle of informed consent in medicine.¹¹ Thomas Percival's publications laid the foundation for moral independence and authority in ethical reasoning, which culminated in the American Medical Association's first code of ethics (1847).^8,12 

The Nuremberg Code (1947) created a framework for modern ethical standards. This code emphasized patient consent and autonomy.^8,11 During the 1960s-70s, bioethics emerged, leading to the creation of ethics committees and Institutional Review Boards (IRBs).^8,11

Contemporary ethical policies focus on respecting and ensuring that patient information is kept private and only shared with authorized individuals, honoring patients' autonomy to choose their own medical care, and treating study subjects with dignity and consideration for their rights and welfare.¹¹

Key areas of medical policies

Healthcare access, patient privacy, public health, and clinical practice are key areas guiding medical policies.¹³ Access policies aim to ensure that all individuals, regardless of location or socio-economic status, can obtain necessary medical services, especially in rural areas with healthcare shortages.¹³ 

Federal programs like Federally-Funded Health Centers, Incentive Programs, Telehealth Innovations, and Broadband Infrastructure Development address these issues.¹⁴ Protecting patient privacy and confidentiality is also crucial, with the Health Insurance Portability and Accountability Act (HIPAA) being a key regulation.^15-16

Public health policies operate at various levels. Research shows that high-income countries focus on environmental health (e.g., Climate change) and communicable diseases, while low-income regions prioritize strengthening health systems.¹⁷

Clinical practice policies include guidelines for patient care, employee safety, drug handling, and data security, ensuring standardized treatment protocols, workflows for safe working environments, proper pharmaceutical management, and robust privacy protection.¹³ 

Importance of medical ethics and policies

Adhering to ethical standards in healthcare leads to improved patient outcomes, increased trust, and better overall health and well-being for individuals and communities.

However, certain medical scenarios present significant ethical and legal dilemmas. The cases of Indi Gregory¹⁸, Alfie Evans¹⁹, and Charlie Gard²⁰, children on life support due to severe genetic conditions, and the case of Archie Battersbee²¹, who suffered a severe accident, exemplify such challenges. The decision to continue life support in each case became the subject of legal battles.

These cases highlight complex ethical issues, including balancing parental rights with medical expertise and determining what constitutes a life worth living. Ethics policies strive to ensure that healthcare services are delivered ethically, fairly, and beneficially, even in the most challenging situations.

Conclusion

Public awareness of ethical policies in the healthcare industry is essential for promoting transparency, trust, patient autonomy, and equitable treatment. By understanding and adhering to these guidelines, healthcare organizations can improve patient outcomes. This awareness ultimately supports a more effective and trustworthy healthcare system. 

References

1.    DuBois, J. M, et al. (2019). Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016. American Journal of Bioethics, 19(1), pp.16–34. https://doi.org/10.1080/15265161.2018.1544305
2.    Understanding the Opioid Overdose Epidemic. (2024). Overdose Prevention. [Online] https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html
3.    Hadland, S. E, et al.(2018). Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians With Subsequent Opioid Prescribing. JAMA Internal Medicine, 178(6), pp.861. https://doi.org/10.1001/jamainternmed.2018.1999
4.    New Study Shows Physician-Targeted Marketing Is Associated with Increase in Opioid Overdose Deaths. (2019). NYU Langone News. [Online] https://nyulangone.org/news/new-study-shows-physician-targeted-marketing-associated-increase-opioid-overdose-deaths#:~:text=Many%20individuals%20cite%20prescription%20opioids%20as%20their%20gateway%20to%20illicit%20opioid%20use
5.    Americans’ ethics ratings of healthcare professionals in the U.S. 2019-2023. (2024). Statista. [Online] https://www.statista.com/statistics/1451600/ethics-ratings-of-healthcare-professionals-us/
6.    Trust levels towards healthcare by country 2022. (2023). Statista. [Online] https://www.statista.com/statistics/1071027/trust-levels-towards-healthcare-in-select-countries/
7.    Nineham, L. (2023). Medical Ethics – The Four Pillars Explained – The Medic Portal. The Medic Portal. [Online] https://www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/#:~:text=Medical%20ethics%20describes%20the%20moral%20principles%20by%20which%20a%20Doctor%20must%20conduct%20themselves
8.    Baker, R. B., & McCullough, L. B. (2008). What is the History of Medical Ethics? In Cambridge University Press eBooks (pp. 1–15). https://doi.org/10.1017/chol9780521888790.002
9.    Muzur, A., & Rinčić, I. (2011). Fritz Jahr (1895–1953) – the Man Who Invented Bioethics. A Preliminary Biography and Bibliography. http://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=107895
10.    WMA - The World Medical Association-Home. (n.d.). WMA - the World Medical Association-Home. [Online] https://www.wma.net/
11.    Govind, A. (2013). A Short History of the Current Approach to Ethical Health Care. UCSF Synapse. [Online] https://synapse.ucsf.edu/articles/2013/11/07/short-history-current-approach-ethical-health-care#:~:text=A%20Short%20History%20of%20the%20Current%20Approach%20to%20Ethical%20Health%20Care
12.    American Medical Association | AMA. (2024). American Medical Association. [Online] https://www.ama-assn.org/
13.    Team, F. I. (2024). Four Pillars of Medical Ethics. Fraser’s Medical. [Online] https://www.frasersmedical.com/blogs/medical-school-interview-ethical-scenarios#:~:text=Clinical%20Ethics,-Clinical%20Ethics%20zeroes&text=The%20ethical%20conundrum%20surfaces%20when,potentially%20preventing%20harm%20to%20others.
14.    Federal Programs and Policies Improving Access to Quality Health Care Services in Underserved Areas. (n.d.). ASPE. [Online] https://aspe.hhs.gov/topics/health-health-care/federal-programs-policies-improving-access-quality-health-care-services-underserved-areas#:~:text=innovations%20in%20telehealth%20and%20other%20communication%2Dbased%20technologies
15.    Health Information Privacy Law and Policy | HealthIT.gov. (n.d.). [Online] https://www.healthit.gov/topic/health-information-privacy-law-and-policy#:~:text=There%20are%20some%20federal%20and%20state%20privacy%20laws%20%28e
16.    Health Insurance Portability and Accountability Act of 1996 (HIPAA). (2024). Public Health Law. [Online] https://www.cdc.gov/phlp/php/resources/health-insurance-portability-and-accountability-act-of-1996-hipaa.html#:~:text=The%20Health%20Insurance%20Portability%20and,the%20patient's%20consent%20or%20knowledge.
17.    Wilson, L, et al. (2023). Global public health policies: gathering public health associations’ perspectives. Global Health Action, 16(1). https://doi.org/10.1080/16549716.2023.2183596
18.    Jefford, B. W. (2023). Indi Gregory: Critically ill baby dies after life support turned off. [Online] https://www.bbc.com/news/uk-england-derbyshire-67400915
19.    Grierson, J. (2018). Alfie Evans dies at Alder Hey hospital after life support withdrawn. [Online] The Guardian. https://www.theguardian.com/uk-news/2018/apr/28/alfie-evans-dies-after-withdrawal-of-life-support
20.    Siddique, H. (2023). Archie Battersbee’s death was an accident, coroner concludes. [Online]The Guardian. https://www.theguardian.com/uk-news/2023/feb/08/archie-battersbee-death-accident-coroner
21.    Charlie Gard: The story of his parents’ legal fight. (2017). [Online] https://www.bbc.com/news/health-40554462

Further Reading

• All Healthcare Content
• The Concept of Human Health and Disease
• Proactive Health: The Shift Towards Preventative Healthcare
• Role of Real-Time Data in Healthcare
• Managing the Explosion of Healthcare Data to Harness its Power