![]() In contrast to the utilitarian concept, deontology is ethics of duty where the morality of an action depends on the nature of the action, i.e., harm is unacceptable irrespective of its consequences. In the above scenario, dilemmas can be dealt ethically and legally if the patients had made advance decision directives about their life similar to decisions on wealth. These ethical issues can be accommodated when dealing with patients who are competent to play a role in decision-making, while posing moral dilemmas in patients who are incompetent, e.g., in patients who are brain-dead (permanent vegetative state), decision-making with regards to withdrawal of life-sustainment/organ donation, etc. Although these concepts look appealing patients feels constrained when clinicians make the decisions, affecting the fundamental ethical principles. According to rule utilitarianism, morally right decision is an action complying moral codes/rules leading to better consequences. These decisions are guided by preformed rules based on evidence and hence provide better guidance than act utilitarianism in decision-making. In rule utilitarianism, no prediction or calculation of benefits or harms is performed. This method would lead to enormous wastage of time and energy in decision-making and are prone to bias. Every action/decision arrived for each patient is confronted with the measurement of balance of the benefits and harms, without examining the past experience or evidence. Act utilitarianism deals with decisions undertaken for each individual case analyzing the benefits and harms promoting overall better consequences. There are two variants of utilitarianism: Act utilitarianism and rule utilitarianism. A few examples of utilitarian approach in medical care include setting a target by hospitals for resuscitation of premature newborns (gestational age) or treatment of burns patients (degree of injury) based on the availability of time and resources. This approach is usually guided by the calculated benefits or harms for an action or intervention based on evidence. This approach could lead to harm to some individuals while the net outcome is maximum benefit. This is also known as the consequentialist approach since the outcomes determine the morality of the intervention. In the utilitarian approach, decisions are chose based on the greatest amount of benefit obtained for the greatest number of individuals. ![]() In utilitarian ethics, outcomes justify the means or ways to achieve it, whereas in deontological ethics, duties/obligations are of prime importance (i.e., end/outcomes may not justify the means). In practical ethics, two arms of thoughts exist in decision-making: Utilitarian and deontological. ![]() Similarly, the practice of fundamental principles of autonomy and informed consent may be breeched in the care of newborn, mentally handicapped or patients in the permanent vegetative state. For example, when a doctor owes a duty to both patient and society, situations of breech in confidentiality may arise. While these definitions are clear to express, exceptions arise in each of these principles during clinical practice. Ethical practice is a systematic approach toward the institution of these principles to approach an appropriate decision-making. Ethics deals with choices, decisions/actions based on the choice and the duties and obligations of a doctor to the best interest of the patient. Much of the modern medical ethics deals with the moral dilemmas arising in the context of patient's autonomy and the fundamental principles of informed consent and confidentiality. They are based on four fundamental principles, i.e., autonomy, beneficence, nonmaleficence, and justice. It deals with the moral dilemmas arising due to conflicts in duties/obligations and the faced consequences. ![]() Ethics is a crucial branch in medicine guiding good medical practice. ![]()
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