Ethics

The further you get into clinical medicine, the fuzzier ethics seems to become. When I looked at theoretical ethical frameworks as a philosophy student, I studied things like deontology or utilitarianism or cultural relativism. At the time, the arguments appeared easy. Physicians should follow these absolute rules: do no harm, respect a patient's autonomy, uphold a patient's dignity, advocate for justice and fairness for all. Healthcare systems should be designed to give the most good for the most people; we should allocate our resources and make decisions based on the utility of those actions. We need to respect differing values of different cultures and elicit the things patients find important.

But as I delve into clinical situations, I find these black-and-white generalizations difficult to parse. Often, multiple prerogatives or imperatives conflict each other. Sometimes, it's not clear whether what we're doing is harming a patient or respecting autonomy or preserving dignity or fair to other people. The system does not know how to allocate resources evenly, and people suffer as a result. We often struggle to understand a patient or family member's perspectives or opinions. And this occurs with well-meaning, well-intentioned physicians. The complexity of a clinical situation is compounded by the social situation, and what results can be an ethical quagmire. Thus, although I always strive to do the right thing, sometimes I struggle to figure out what that is.