Ethical Considerations

You may wonder why an introductory chapter on interviewing contains a section on ethics. What is it about the process of talking with patients that calls for responses beyond our innate sense of morality? Ethics are a set of principles that have been created through reflection and discussion to guide our behavior. Medical ethics, which guide our professional behavior, are not static, but several principles have guided clinicians throughout the ages. Usually our ethical approach is instinctive, but even as students you will face situations that call for applications of ethical principles.

Some of the traditional and still fundamental maxims are as follows:

■ Nonmaleficence or primum non nocere is commonly stated as "First, do no harm." In the context of an interview, giving information that is incorrect or not really related to the patient's problem can do harm. Avoiding ^ relevant topics or creating barriers to open communication can also do ^ harm. Your success in facilitating the patient's full expression of experiences, ^ thoughts, and feelings determines the quality of your assessment.

■ Beneficence is the dictum that the clinician needs to "do good" for the patient. As clinicians, our actions need to be motivated by what is in the patient's best interest.

■ Autonomy reminds us that patients have the right to determine what is in their own best interest. This principle has become increasingly important over time and is consistent with collaborative rather than paternalistic patient relationships.

■ Confidentiality can be one of the most challenging principles. As clinicians, we are obligated not to tell others what we learn from our patients. This privacy is fundamental to our professional relationships with patients. In the daily flurry of activity in a hospital, it must be carefully guarded.

Issues in health care that extend beyond our direct care of individual patients to complicated choices about the distribution of resources and the well-being of society continue to emerge. A broadly representative group that initially met in Tavistock Square in London in 1998 has continued to work on an evolving document of ethical principles to guide behavior in health care for both individuals and institutions. A current iteration of the Tavistock Principles is provided below.

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