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An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.

Admittedly, most of the definitions of euthanasia are descriptive, and there are multiple interpretations in the literature. [...]in the interest of clarity the following comments on definition and usage of the term are offered. Consent of the subject (person who dies as a result of the action) is crucial as bioethicists are in general agreement that medicalized killing of a person, irrespective of the intent, without the person’s consent (involuntary) or if the person is unable to give consent (nonvoluntary) cannot be considered euthanasia [4]. [...]the term euthanasia should be used within the confines of the parameters of these elements. The Doctrine of Double Effect makes a distinction between intended effect and unintended but foreseen effect of an act that has double effects – one good and one harmful – and is justified if the following 4 elements are satisfied: the nature of the act, intention of the doer, distinction between means and ends, and proportionality (the intended good effect is proportionally more than the unintended bad effect). [...]a physician’s intention to relieve suffering of a patient by appropriate drugs including opioid overrides the possible unintended bad effect or outcome.

Acute and chronic pulmonary and cardiac diseases often have a high mortality rate, and can be a source of significant suffering. Palliative care, as described by the Institute of Medicine, “seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure. Palliative care in this broad sense is not restricted to those who are dying or those enrolled in hospice programs.” The American College of Chest Physicians strongly supports the position that such palliative and end-of-life care of the patient with an acute devastating or chronically progressive pulmonary or cardiac disease and his/her family should be an integral part of cardiopulmonary medicine. This care is best provided through an interdisciplinary effort by competent and experienced professionals under the leadership of a knowledgeable and compassionate physician. To that end, it is hoped that this statement will serve as a framework within which physicians may develop their own approach to the management of patients requiring palliative care.

Acute and chronic pulmonary and cardiac diseases often have a high mortality rate, and can be a source of significant suffering. Palliative care, as described by the Institute of Medicine, \"seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure... Palliative care in this broad sense is not restricted to those who are dying or those enrolled in hospice programs.\" The American College of Chest Physicians strongly supports the position that such palliative and end-of-life care of the patient with an acute devastating or chronically progressive pulmonary or cardiac disease and his/her family should be an integral part of cardiopulmonary medicine. This care is best provided through an interdisciplinary effort by competent and experienced professionals under the leadership of a knowledgeable and compassionate physician. To that end, it is hoped that this statement will serve as a framework within which physicians may develop their own approach to the management of patients requiring palliative care.

Copyright © 2006 S. Karger AG, Basel