Engaging in biomedical ethics in my first semester of physician assistant school has allowed me to outline a basis for the first years of my career through beneficence, autonomy and confidentiality, provided by the motives behind my chosen profession and the aspects of the profession that I find most important (Kirk, 2019).

While initially deciding which healthcare profession to pursue was difficult, when I understood the scope and principles of the physician assistant (PA) profession, I realized it best reflected my professional and personal goals and values. From personal family experience of the benefits of an efficient health care team, such as an early diagnosis of breast cancer in my mom to a challenging diagnosis of cardiac sarcoidosis in my dad, I recognized being in medicine to help others and being part of a collaborative team to improve patient care was the career I desired. Along with this, I have observed my mother’s career as a PA and wanted to seek the same career to be as compassionate, empathetic and as much of a lifelong learner as her. The care, emphasis and positive feedback I have directly heard from her patients, along with her supportive and collaborative relationship with her supervising physician, ultimately propelled me into the PA profession (Andersen, 2018). All of my experiences and the traits of PAs and the profession itself, only briefly described here, have truly influenced my choice and dedication to this profession.

There are a variety of aspects of clinical practice that I believe will be most important to me as a future PA. One of the most integral aspects is a patient-centered approach to providing effective communication and care. By allowing the patient to speak, relay their concerns and understanding the psychosocial components affecting their health, I am able to not only provide better care but learn of other factors that could be affecting the patient, that would otherwise be unbeknownst to me. This view mitigates the paternalistic idea of me being the only individual involved in the patient’s care and simply extending my medical knowledge onto the patient, without concern for their values and goals of care (Fortin et. al, 2012). In addition, continuing to evaluate the changes in medicine is an imperative clinical aspect that is important to me. Through lifelong learning by continuing medical education lectures or independent learning through journals or online databases, I will be able to provide patients with the most accurate and current medical knowledge as well as new studies or changing recommendations. The ability to integrate both patient-centered interviewing skills and a dedication to lifelong learning are both vital to me and will profoundly benefit me and patients in clinical practice.

The principles of autonomy, beneficence and confidentiality, of which I have learned this semester, I anticipate will play the strongest role in my ethical decision-making in clinical practice. One principle vital to my clinical practice will be autonomy, which means self-determination, in essence the right for an individual to make their own decisions. The meanings of autonomy are as free action which is the right to do as one chooses and effective deliberation, the ability for an individual to rationalize their thought process. In addition, autonomy is as moral reflection, being cognizance of one’s own values and how said values are aligned with their choice and authenticity, an individual’s choice in care is consistent with their other choices (Yeo et al., 2010). Beneficence is the act of doing good and through this good, a harm may be reduced, which can be related to nonmaleficence as it means do no harm. For beneficence to stand, the harms and benefits must be present and prioritized and the application of beneficence must provide maximum benefit to an individual with minimal harm (Yeo et al., 2010). The last principle of confidentiality is founded upon the relationship between a clinician and patient. It reflects the respect for patient personhood through trust and by understanding the complexity of patient information and disclosure of it (Kirk, 2015).

The use of beneficence in reflection to lifelong learning addresses the act of doing good for patients. A patient seeking medical care is often looking for a competent and knowledgeable clinician who is continuously up to date on current patient care. For example, a patient diagnosed with breast cancer should know all of the available options, or the option of no treatment at all, when discussing next steps. If a clinician is actively engaging in learning various treatment options, its acute and chronic adverse effects as well as the patient’s goal of care, the patient will be able to make a better-informed decision. However, if this clinician does not use lifelong learning, they may fail to know that, for example, a double mastectomy with certain implants has a higher risk for another, rarer type of cancer. If this is never discussed, the patient is not provided with all of the risks and benefits of the treatment and therefore cannot consent to a care reflective of their values or goals as it is possible that the risk of another cancer may deter them from a double mastectomy at all. This can result in no establishment of the maximization of benefit and minimization of harm to the patient. In addition, beneficence also furthers a patient-centered approach, as it is opposite to the paternalistic view of medicine where the clinician decides the patient’s care with solely their justification.  The act of a clinician integrating a patient’s values, goals and feelings into their care reflects beneficence in that it treats the patient as a whole person, not only their disease or symptom, thus expanding and eliciting the true realm of how many factors can contribute to the health of a patient.  

A patient-centered approach fosters autonomy by exemplifying the patient’s right to participate in their own healthcare. The act of allowing a patient to express their own opinions or goals is supported by free action and in addition provides the patient with the greatest right, which is to deny treatment or other healthcare engagements. As stated, a clinician utilizing patient-centeredness will allow the patient to identify their own morals, which is reinforced by autonomy as moral reflection. This additional consideration will allow a patient to understand their own values and how it aligns with their healthcare decision. Autonomy, specifically as free action and effective deliberation, fosters lifelong learning in clinical practice, as a clinician who continues to educate themselves can provide a patient with more options and potential consequences. This in turn does not withhold information from a patient and thus enhances their choosing ability and reasoning.  

Lastly, the principle of confidentiality largely supports patient-centeredness in that it builds upon the relationship of the clinician and patient. The act of providing a patient with the ability to establish their own beliefs and emotions, not only exemplifies respecting the patient but can solidify the patient’s trust in the provider as someone who cares about them as a whole. This increased trust and confidence can improve how the patient views healthcare and their own health and therefore allow my clinical practice to maximize the beneficial effects for the patient and minimize harm, which also reflects directly back to beneficence.

Ethics in healthcare has enabled me to use the core principles of beneficence, autonomy and confidentiality to establish an ethical outline for the beginning of my clinical practice as a PA through both why I chose this profession and what clinical aspects are most important to me.

References:

Andersen, Caleigh. 2018 Personal Statement.

Fortin, A.H., Dwamena, F.C., Frankel, R.M. & Smith, R.C.(2012). Smith’s

Patient-Centered Interviewing: An Evidence-Based Method, 3^rd ed. McGraw-Hill/Lange. Chapter 3.

Kirk, TW. (2019). Reflection Essay Instructions and Writing Guidelines for HPPA 514, pp. 1

Kirk, TW. (2015).  Confidentiality.  Oxford Textbook of Palliative Medicine. [5th ed.] New York/London: Oxford University Press, pp. 279-284.

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

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