Patient preferences,
quality of life issues, and medical indications are all examples of ethical
concerns that must be taken into account when working through ethical
dilemmas. Consideration of legal issues is not a factor in ethical decision
making. If the patient’s insurance company refuses to pay for the indicated
procedure (in this case, hysterectomy), the ethical principle of justice (the
patient should be given her due) is being challenged. Autonomy is the ethical
principle whereby the patient has the right to self-determination.
Therefore, the needs of society (a contextual issue) are not considered as a
factor of autonomy. Informed consent requires that the patient be able to
understand the risks, benefits, and alternatives of a particular medical procedure.
If the patient is unable to understand the medical information, a
legal guardian can be assigned to make those decisions for him or her. A
patient’s desire not to have his or her medical history discussed with anyone
else involves the ethical concept of confidentiality.
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