Carly Schreiber

Professor Kirk 

Biomedical Ethics Reflection Paper 

This essay captures a draft ethical framework guiding my first five years of clinical practice including both my decision to become a physician assistant along with the anticipated, most important aspects of clinical practice.

My decision to pursue the career of physician assistant was multifaceted. From a patient-centered perspective, the ability to help individuals both physically and emotionally built on personal relationships drew me in. I desired greatly to play a role in society and the blend of medical and psychosocial aspects excited me. From a more career-focused perspective, there were two unique characteristics about this career namely its flexibility to move throughout various specialties and its collaborative yet autonomous nature. As an individual with several passions and desire for newness, the ability to graduate with a Master’s degree, enter into any field and switch fields throughout the career was unique and exciting. Not having to decide on one specialty to practice in for the rest of my career life removed pressure and created opportunity. Additionally, the balance between collaboration and autonomy is one that my personality would strike beautifully with my appreciation both for teamwork and team-building skills along with leadership skills. 

There will be endless aspects of clinical practice that will be important to me as I enter and gain experience in the world of being a licensed, certified physician assistant. However, there are three that stand out to me with potential of being the most important once I am working in clinical practice – patient-centered care, effective patient education and the balance of proficient clinical and psychosocial skills. After learning in several classes what patient-centered care consists of and how to effectively deliver that type of care, it immediately became a goal of mine to focus on its values as a healthcare provider as I believe strongly in providing care that concentrates on serving the patient. Additionally, since my entrance into this graduate program I have already been educated on endless matters and subjects and would love to take my education and share it with patients so that they could better provide for and take care of themselves. Lastly, as mentioned above, the balance between clinical and psychosocial skills in caring for patients both medically and emotionally was an aspect of this career that hooked me. Patients’ health depends greatly on both features, potentially even equally, and so I aspire to serve and treat every aspect of patient needs. 

Three ethical principles we discussed at length this semester that I anticipate will play the strongest role in my ethical-decision making in clinical practice are autonomy, non-maleficence and beneficence. Autonomy is generally defined as self-determination, the right to make independent decisions concerning one’s own life and well-being. The principle of autonomy contains four tenets namely, free action or the ability to do what one wishes without being forced into something they do not wish, effective deliberation, authenticity and moral reflection. (Yeo, 2010).  Next, non-maleficence is the goal of reducing harm in treating patients by inflicting the least amount of harm possible to reach a desired outcome. This principle requires the consideration of balance between harms and benefits as it is unusual that a treatment, whether it be medication or procedure, will bring absolutely no harm to a patient. Lastly, beneficence outlines the orientation toward the good of the patient which includes the balance between the patient’s rights and liberties along with professional knowledge and perceptions of what is best for them. (Yeo, 2010). 

The ethical principles of autonomy, non-maleficence and beneficence correspond with the aspects of clinical practice I find to be most important. First, the principle of autonomy, specifically the tenet of free action, supports my goal of providing patient-centered care. It is common that practitioners, especially over time with experience and eventually potential burnout, begin to treat patients according to their perspectives, ideals and wishes only. Unfortunately, due to the scientific knowledge a healthcare provider holds along with their expertise and experience, it is easy to ignore what the patient desires as many times it will be misaligned with the practitioner’s. Although patients are typically less educated and experienced in healthcare, the job of a healthcare provider is to provide for the patient. Even if a provider believes they’re providing for the patient by treating them according to their ideals, taking the patient out of the equation is unethical, granted the patient has decision-making capacity. For example, one case we encountered in class included confidentiality regarding intimate partner violence. According to the practitioner, it would be best for the patient to disclose this information and therefore better treatment would be provided. However, the patient desired this information remain confidential. Although from a medical standpoint, disclosure would be most effective, the practitioner must work to fulfill patient needs (Jenkin, 2006). In order to allow for patient autonomy and specifically free action, they must be allowed the space to make independent decisions. As a practitioner myself, I hope to be able to compartmentalize and differentiate between my personal biases and opinions and what the patient requests from me. While we hope to treat patients effectively according to our knowledge and expertise, treating patients according to their will is treating effectively even when the two misalign. 

Next, the principle of non-maleficence supports my goal of providing effective patient education. The general society is uneducated and unaware of basic medical knowledge and health tips. Non-maleficence aims at reducing harms for patients. With proper patient education and appropriate counseling, practitioners can do a great deal of reducing harms for patients. While it is unrealistic to expect to change a patient’s life habits with a few minutes of education,  the goal is harm reduction, not harm extinction. For example, counseling a patient on the harms of smoking and its cessation’s benefits will almost never result in a patient quitting cold turkey, and healthcare providers do not expect that. However, the goal of patient education is to provide enough true, convincing and compelling information that it will assist the patient in simply reducing the harm they cause themselves. I do not aim to turn a patient’s life around, rather I aim to aid in the making of small changes to gradually improve my patients’ lives. 

Lastly, the principle of beneficence supports my goal of striking the balance between proficient clinical and psychosocial skills. What initially attracted me to pursuing a career as a physician assistant was its harmony of these two imperative aspects. Both medical and emotional aspects prove to greatly affect a patient’s medical condition and in order to become the best practitioner possible, one must be skillful at providing both. Beneficence aims at evaluating and carrying out what is best for the patient, taking into account their personal perceptions and definitions of health and its provisions of care. In order to provide the best possible care for patients, who each present with their own complexities, predispositions and biases, practitioners need to serve patient demands based on both their medical and emotional needs. 

Between my decision to become a physician assistant along with the aspects of clinical practice most important to me based on the ethical principles of autonomy, non-maleficence and beneficence, I intend to practice with an ethical framework aimed at focusing on and serving patient needs. 

Sources: 

Jenkin, A, Millward, J. (2006).  A moral dilemma in the emergency room: Confidentiality and domestic violence . Accident and Emergency Nursing, 14(1), 38-42.

Yeo, M et al. (2010). Autonomy  [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.

Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.