Rural Emergency Medicine

Evidence based medicine is the current recommended clinical science tool for aiding decision-making and best medical practice. But what about the areas that are not applicable to an evidence based medicine assessment?
What about determining what is right and what is wrong?

Medical ethics has spanned for over two thousand years, derived from the work of ancient philosophers such as Hippocrates. In modern society, the law acts to a degree to determine what is just, however there are still gaps where the choice solely rests upon the practitioner.

The modern healthcare environment provides situations in which Doctors can be overwhelmed with the complex and multifaceted ethical choices they have to make. In light of this most Australian Medical Schools have since incorporated an ethics component into their courses. The four key ethical principles espoused by UQ's School of Medicine, to guide clinical decisions are;
  • Autonomy: Self-determination, free will, self-rule
  • Beneficence: 'Do Good'
  • Non-maleficence: ‘Above all, do no harm’
  • Justice: Fairness, rightness, equity, integrity
Two of these principles, non-maleficence and beneficence are synonymous with Hippocratic obligations. The two others (autonomy & justice) are an innovation of recent time and give greater powers to patients to be the masters of their disease.

In addition, the World Medical Association has written up a Medical Ethics Manual to guide both medical students and practitioners in ethical decision making.

To conclude this diatribe, I leave you with some food for thought.

Further Resources
1. Beauchamp T L, Childress J. Principles of Biomedical Ethics, 5th edn F. Oxford University Press, 2001

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