Abstract
Healthcare professionals often need to make clinical decisions that carry profound ethical implications. As such, they require a tool that will make decision-making intuitive. While the discussion about the principles that should guide clinical ethics has been going on for over two thousand years, it does not seem that making such decisions is becoming any more straight forward. With an abundance of competing ethical systems and frameworks for their application in real life, the clinician is still often not sure how to proceed in the face of ethical dilemmas, either due to a lack of background ethical knowledge or experience in applying it. This paper will discuss whether considering what one would expect one’s friend to do if one was the patient, or what would one think they would do for a friend if they were the patient, can be a helpful, more intuitive, tool for clinical decision-making that can produce outcomes that are congruent with major ethical systems.
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Notes
The perspective of friendship is perhaps the reference perspective for all our relationships with others. This perspective allows us not only to make good proxy decisions, but also ensures that we orient ourselves towards others with due respect and consideration (General Medical Council 2019).
I thank the reviewer for bringing this to my attention.
The friendship framework could also be potentially used to help determine when is it appropriate for a clinician to raise a conscientious objection – for a patient should perhaps accept a clinician’s moral boundary as we respect our friends’ moral boundaries.
This example allows the reader to explore more the characters involved, if the reader should wish to do so; also it has been analysed extensively previously (Hughes and Lantos 2001). Interestingly, the issues of assisted suicide and euthanasia have been discussed in various episodes of the franchise (see e.g. The Next Generation S4E22, Deep Space 9 episodes S4E14, S4E23 and S5E2 or Voyager episodes S1E9, S2E18; S – season, E—episode).
For example, trainee Clinical Scientists receive some lectures on clinical and research ethics as part of their training (NSHCS 2017a; NSHCS 2017b), but it amounts to only to a couple of hours of lectures. Yet, they might be faced with difficult ethical problems, such as issues relating to non-disclosed diagnosis of cancer.
This becomes less of a problem is certain circumstances, when we know the preferences of a friend or if we are treating a bioethicist with well established views on certain topics. E.g. John Harris claimed that resources should only be spent on those over 70 if they would not deprive those younger than 70 from access to necessary medical treatment (Harris 2001). Under the friendship framework we should consider his wishes in the decision-making process, and perhaps prioritise the treatment of younger friends, as Harris is himself more than 70 years old. Of course, if Harris has changed his mind on this issue we should take that into account at the time of making the decision.
Beauchamp and Childress highlight several times in their text that none of the principles takes precedence over another.
Pellegrino and Thomasma (1993), in their book, try themselves to reconcile Principlism with Virtue Ethics.
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The author wants to thank Eduardo A. Hernandez-Cruz, Fotini Hamplova, and Matthew James for help in preparing this manuscript, and the reviewers for their constructive comments.
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Pruski, M. Friendship as a framework for resolving dilemmas in clinical ethics. Monash Bioeth. Rev. 39, 143–156 (2021). https://doi.org/10.1007/s40592-021-00141-5
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DOI: https://doi.org/10.1007/s40592-021-00141-5