An overview of context and conflicts in principles of ethics in healthcare settings in Bhutan

Abstract

Healthcare setups are becoming sophisticated and mechanical, often disregarding human, emotional, and socio-cultural perspectives. This leads to forms of ethical conflicts that may not result in making the right choices for the patient and family members. Bhutan is positioned in a unique socio-cultural context that has strong influence on the core principles of ethical medical practice. The core principles of ethics in medical practice are autonomy, beneficence, non-maleficence and justice. It is observed that a form of relational autonomy may be a dominant force where family members make choices on behalf of patients. The healthcare professionals may be nudging patients and family members towards certain healthcare choices. There are instances in which the treatment decisions made by the healthcare professional is seen as lacking beneficence by family members, while patients’ socio-cultural practices are seen as lacking beneficence by healthcare workers. While health policy and strategy aim at improving health equity, there are instances in clinical practice where distributive justice is breached. With attrition of healthcare workers, distributive justice has come into question as the healthcare workers remaining behind are faced with increasing work pressure, burnout and compassion fatigue. In end-of-life decision making, there are situations of intense conflict regarding resuscitation attempts and continuation of non-life-saving care processes. The medical curriculum for doctors, nurses and traditional medicine physicians includes ethics education as part of their training. This article provides a contextual set-up of how ethical principles intertwine with medical practice in Bhutan.