By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD
June 27, 2018
As a doctor, you may confront difficult questions, for which the right answer on how to proceed, isn’t clear.
How do you determine the right course to take when presented with an ethical question in optometry?
Ethical eyecare professionals respect and follow the four basic principles of health-care ethics. These four principles are: autonomy, justice, beneficence and non-maleficence. Let’s consider each one.
Autonomy means the patient must be fully informed, understanding all the risks, benefits and likelihood of success of a prescribed treatment plan, in order to make a decision about their own care free from coercion. To be ethical we need to explain, in words patients understand, the complete diagnosis and treatment plan. Patient surveys say that doctors do not communicate well. The irony is that doctors think they are excellent communicators. Autonomy also demands that no matter how much you believe the patient should follow your treatment plan, you should never engage in “hard sell” closing techniques. A few years ago a dental hygienist tried to use a hard sell technique on me. As a patient, I was offended and angry. This was a violation of the principle of autonomy.
Simply stated, justice is giving others what is due them. It means you should not treat people unequally. A good way to think of this is that you are the patient’s eyecare professional, you are not their banker. Under this principle, making a care decision based on what you think the patient can or cannot afford is unethical. Are you presenting to every patient what will improve their life in each of the arenas where they live – home, school, work and play? Or, do you compromise your treatment plan because you “believe” they cannot afford the best treatment plan? To follow the ethical principle of justice, always present the best treatment plan and then let the patient decide what they can or cannot afford.
Beneficence is best described as doing good to others. The practical application of this principle is that before you can do good to others in your professional role, you need to make sure that you have the most current knowledge and skills in order to actually do good to others. CE is not something that we begrudgingly sit through to maintain licensure. CE is something we seek out eagerly in order to have the most current knowledge and skill sets necessary do good to others. If you are sitting in the back of the room during CE reading the newspaper or surfing through e-mail, you should re-examine your understanding of the ethical principle of beneficence.
Non-maleficence means that we should not harm our patients or others in society. We follow this principle when we prescribe tests or treatments where the potential benefits outweigh the risks of harm. On a surface level, this principle tells us to make sure we are using appropriate disinfection techniques in our offices. It even has implications in managing protected health information. But on a deeper level, this becomes an interesting issue when treating a corneal ulcer. Should every ulcer be cultured?
Most doctors will start a course of treatment, see how the ulcer responds, then modify the treatment if necessary. What if you started the incorrect course of treatment because you did not culture the ulcer? Is this a violation of non-maleficence? This is where evidenced-based medicine and treatment protocols can help us. But that means that we need to be up-to-date with both evidenced-based medicine and treatment protocols.
Take this week to make sure you are following these four ethical principles in your practice.