The concept of autonomy does not allow a patient’s wishes to take precedence over good medical judgment.
For children, parents are the surrogate decision makers, except in circumstances in which the decision is life threatening and might not be the choice a child would make later, when adult beliefs and values are formed.
Creating a highly professional environment of safe culture, lack of harassment, high professional behavior standards, and disclosure of unexpected outcomes benefits both patients and health professionals.
The practice of gynecology, as with all branches of medicine, is based on ethical principles that guide patient care. These principles and concepts create a framework for ethical decision making that applies to all aspects of practice:
Autonomy: a person’s right to self-rule, to establish personal norms of conduct, and to choose a course of action based on a set of personal values and principles derived from them
Confidentiality: a person’s right to decide how and to whom personal medical information will be communicated is part of autonomy
Beneficence: the obligation to promote the well-being of others or, in medicine, to benefit the patient through meeting a goal of medicine by the care offered
Covenant: a binding agreement between two or more parties for the performance of some action
Fiduciary Relationship: a relationship founded on faith and trust and the obligation to act in a trustworthy manner
Informed Consent: the patient’s acceptance of a medical intervention after adequate discussion and consideration of the nature of the procedure, its risks and benefits, and alternatives
Justice: the right of individuals or groups to claim what is due to them based on certain personal properties or characteristics
Maleficence: the act of committing harm (Nonmaleficence obliges one to avoid doing harm)
Patient and Physician: Professionalism
Health care providers fulfill a basic need—to preserve and advance the health of human beings. Despite the challenges imposed by the commercial aspects of the current medical environment, for most physicians, the practice of medicine remains very much a “calling,” a giving of oneself to the greater good. The behavior of health professionals is judged against this list of ethical principles and concepts by other professionals and the public who share the belief in the “calling” of medicine. There are examples of unprofessional behaviors that mar this professional image. They are demonstrably easier to see in others than ourselves, including unprofessionalism in relation to drug companies, shouting at or mistreating others, or inappropriate behaviors with students, patients or colleagues, that abuse professional standing such as boundary violations or learner abuse (1). Lapses do not always represent inherent ﬂaws in professionals, “most lapses represent deficiencies in judgment and skill. They occur when the physician in question fails to recognize the presence of a challenge to professionalism or lacks the skill to handle a challenge at the time it occurs” (2). As Lucey and Souba note, the solution to unprofessional behavior is not recrimination but development of a set of skills that allow professionals to recognize and address these professional challenges—and those skills need to be developed and reinforced not just by individuals but by the whole community of practicing physicians throughout their professional careers (2). Professionalism is as much an ongoing educational endeavor as is learning new procedures or techniques, and “we should assume that our peers want to be professional and that they will welcome interventions from a trusted colleague when circumstances suggest that a lapse is imminent” (2). Creating an environment where we can help one another in this way improves the quality and safety of the care for our patients by preventing unprofessional behavior. An environment without fear of recrimination, harassment, or unprofessional behavior promotes speaking up for patients’ interests and promotes safer environments for everyone. It is a fundamental principle of excellence in patient care.