Mark E Borden MD | What Constitutes an Ethical Issue in Medicine?

Ethical issues in healthcare involve situations where moral values, obligations, or duties come into conflict, requiring a thoughtful resolution. These issues often arise when a healthcare provider must make a decision that affects a patient’s well-being, autonomy, or access to care, especially when multiple courses of action may have varying ethical implications.

Mark E Borden MD, defines an ethical issue as a situation where there is uncertainty about the right course of action or when competing values must be weighed against one another. Such issues can involve dilemmas around life and death, patient autonomy, resource allocation, confidentiality, and professional integrity. These conflicts require healthcare professionals to recognize the ethical dimensions of their decisions and to approach them systematically.

Mark E Borden MD | Steps to Recognizing Ethical Issues

1. Awareness of Moral Conflict: The first step in recognizing an ethical issue is developing an awareness of potential moral conflict. Ethical dilemmas often emerge when a healthcare provider is faced with choices that challenge their sense of what is right or best for the patient. For example, Dr. Borden highlights cases where a patient refuses life-saving treatment, prompting a conflict between respecting the patient’s autonomy and the healthcare provider’s duty to preserve life. Recognizing that this tension exists is the starting point for addressing the ethical issue.
2. Identifying Conflicting Values: Ethical dilemmas often involve conflicting values or principles. For instance, a physician might be torn between two fundamental ethical principles—autonomy (respecting the patient’s right to choose) and beneficence (acting in the best interest of the patient). Dr. Borden suggests that identifying which values are in conflict is critical in defining the ethical issue clearly. For example, a patient may want to pursue aggressive treatment for cancer, but the healthcare provider might believe that palliative care is more appropriate based on the patient’s condition. This conflict between patient autonomy and physician-guided beneficence forms the crux of the ethical dilemma.
3. Clarifying Stakeholder Interests: Ethical issues often involve multiple stakeholders—patients, families, healthcare providers, and, in some cases, institutions. Dr. Borden stresses the importance of understanding how each stakeholder’s interests may influence the ethical issue. For example, a family might request life-sustaining treatment for a loved one in a vegetative state, while the medical team believes it would cause unnecessary suffering. Understanding the perspectives and motivations of all parties involved helps clarify the ethical issue and ensures that it is framed accurately.