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The ethical principle of respect for patient autonomy is firmly grounded in western ethical principles valuing individual freedoms. This chapter talks about autonomous choices, presenting a case of a 35-year-old man with colectomy. Of the four foundational principles in medical ethics: beneficence, nonmaleficence, respect for autonomy, and justice, the principle with the strongest influence in the United States is respect for personal autonomy. Three conditions must be met in order for an act (or choice) to be autonomous: a person must act with intention, with understanding, and without controlling influences. In the informed consent process, physicians have ethical obligations to avoid controlling influences that invalidate autonomous choice. Generally speaking intentional acts require planning, although not necessarily reflective thought or strategy. Coercion and manipulation are unethical because they violate the principle of respect for patient autonomy, and because manipulation often involves deception and violates physician obligations of veracity.
Ethical principles of beneficence and nonmaleficence require that physicians strive to improve medical knowledge to improve patients' lives and avoid harmful or ineffective treatments. Publication serves critical processes in promoting the integrity and efficacy of the medical profession, and thereby in promoting patient wellbeing. Publication is a critical part of academic medicine, and sets scholarly work apart from the practice of medicine. Plagiarism violates ethical principles of nonmaleficence and justice. Authors have ethical obligations to be truthful regarding credit for the work and outcomes of research. Fabrication and falsification of data, plagiarism, misleading assignment of authorship and redundant publications all are detrimental to the mission of medical publication. Peer reviewers have obligations to be competent, fair, and balanced, and free of conflicts of interest in reviewing medical manuscripts. Journal editors have parallel responsibilities to assure accuracy in the medical literature.
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