Professional Conduct

THE FOUR PILLARS

1. Autonomy Patients have the right to make their own decisions about their care. Your job is to inform, not control.

  • Requires informed consent

  • Applies to competent adults only

  • Includes the right to refuse treatment even if it causes death

2. Beneficence Your duty to act in the patient's best interest. Do good.

  • Always ask: what outcome genuinely helps this person most?

  • Sometimes conflicts with autonomy when patients make harmful choices

3. Non-maleficence Do no unnecessary harm.

  • Every intervention carries risk — the benefit must outweigh it

  • Includes physical, emotional, and psychological harm

4. Justice Fair and equal treatment for all patients.

  • Resources should be distributed fairly

  • No patient gets better or worse care based on race, religion, wealth, or status

  • Includes advocating for patients who face systemic barriers

THE MOST COMMON ETHICAL CONFLICTS

Autonomy vs Beneficence Patient wants something that isn't in their best interest. Example: patient refuses chemotherapy that could save their life → Respect autonomy if they are competent and informed

Autonomy vs Non-maleficence Patient's choice will cause them harm. Example: patient refuses insulin for diabetes → Ensure they understand consequences, then respect their decision if competent

Justice vs Beneficence Limited resources mean you can't give everyone everything. Example: one ICU bed, two critical patients → Allocate based on clinical need and likelihood of benefit, not personal characteristics

Confidentiality vs Duty to Protect Patient tells you something that puts others at risk. Example: patient with seizures refuses to stop driving → In Canada you have a legal duty to report this to authorities despite confidentiality

The key distinction: Passive refusal of treatment by a competent patient = respect autonomy Active self harm by a patient in crisis = intervene and protect

ALBERTA SPECIFIC LAWS AND REPORTING BODIES — MASTER REFERENCE

Who to report to:

  • Chief of Medicine — internal hospital issues, impaired colleagues, conflict of interest

  • Program Director — residency concerns, threats to your evaluation

  • College of Physicians and Surgeons of Alberta (CPSA) — physician misconduct, professional violations

  • Alberta Health Services — reportable diseases like HIV, public health concerns

  • Alberta Transportation — seizure disorders in drivers

  • Child Protective Services — child safety concerns

  • Hospital Administration — institutional policy violations

  • Ethics Committee — complex ethical decisions needing team input

Key Alberta Laws:

  • Traffic Safety Act — mandatory reporting of seizure disorders in drivers

  • Public Health Act — mandatory reporting of HIV and other reportable diseases

  • Mature Minor Doctrine — no fixed age, capacity based assessment

  • MAiD legislation — patient must request themselves while competent, 18+

Key Concepts:

  • NETCARE — Alberta's prescription monitoring system

  • Disclosure — mandatory honest reporting of medical errors to patients

  • Conscientious objection — can refuse but must refer

  • Substitute decision making — next of kin decides based on what patient would have wanted