Features

Ethical principles in medical practice

Published

1 year ago

2025/08/4

Image courtesy https://opmed.doximity.com/articles/moral-physicians-are-not-enough

The practice of medicine is regarded as an honourable enterprise due to its emphasis on serving humanity and promoting public health. In addition to being equipped with a combination of clinical expertise, technical skill [where applicable], and interpersonal skill, the medical practitioner is expected to act with moral integrity. The moral and ethical principles, common to all mankind, expounded in ancient Greek philosophical thought, was first integrated with medical practice by Hippocrates [5^th Century BCE] in an attempt at enhancing professional standards. With the passage of time, medical ethics were formulated into codes and oaths [e. g. Hippocratic Oath], and in 1803, the English Physician, Thomas Percival, founded the modern ethical principles in medical practice.

Beneficence, nonmaleficence, autonomy and justice have gained acceptance as the four ethical principles of medical practice – the first two advocated by Hippocrates –”to help and do no harm” – and the latter two developed with the passage of time.

The following overview of ethical principles in medical practice was written in view of recent media reports of alleged transgressions in ethical conduct by some medical practitioners. It was written with the intention of raising awareness of the general reader and the student of medicine:

BENEFICENCE

In the medical context, the term beneficence [Latin: facere: ‘to do’, bene: good] refers to the obligation of medical practitioners to act in a manner beneficial to their patients and promote their welfare: ‘to provide competent and trustworthy service’; and ‘to act with empathy and kindness’. The term also applies to the role played by healthcare facilities – state and private.

NONMALEFICENCE

In contrast to beneficence, which is a ‘positive requirement’, nonmaleficence refers to ‘first do no harm’ [Latin: male: ‘harm’, ‘evil’]. From a medical perspective, it refers to the need to refrain from ‘unnecessary and unjustified’ therapeutic interventions.

AUTONOMY

According to the moral theory of German philosopher Immanuel Kant [1724-1804], autonomy [self-determination] stood for the ideal of ‘free will driven to action by rational thought, and not determined by an inner desire or by an external force [coercion]’. In its application to clinical practice, the medical practitioner is obliged to disclose all relevant medical findings and treatment options in order for the patient to have a role in decision-making, and exercise his/her right to self-determination. It requires the application of codes of practice such as informed consent, truth-telling and confidentiality, which are based on the right of self-determination; but not without challenges.

* Informed Consent

Elements of [or preconditions for] valid consent for a medical or surgical procedure are, the patient 1. must be competent to understand and decide, 2. receives full disclosure, 3. Comprehends the disclosure, 4. acts voluntarily, and 5. consents to the proposed action.

Some question the universal applicability of the above requirements as they are developed in western culture. In defence it is argued that they are based on core human values.

Competence is the key requirement in obtaining valid consent, but is often relative. Competence usually becomes an issue when a recommended treatment is refused. Law tends to presume competence except in those suffering from ‘major’ mental illness and in minors. Standards generally adopted for determining incompetence are based on the patient’s, 1. inability to state a preference or choice, 2. inability to understand one’s situation and its consequences, 3. inability to reason through a consequential life decision.

In the case of a presently incompetent but previously competent patient, the following approaches are adopted in decision making: 1. taking into account the patient’s previously expressed preferences, or 2. involvement of a surrogate decision-maker [or guardian] who either exercises a substituted judgement in accord with the patient’s authentic values or makes a ‘best interests’ judgement.

* Truth-telling

An autonomous patient has the right to request full disclosure of his or her medical condition and prognosis. It is an essential component of the therapeutic relationship based on trust.

The medical practitioner is obliged to provide such medical information, with thoughtfulness and sensitivity, however grave the condition is. Nevertheless, in some cultures, the medical practitioner is expected to disclose information regarding serious illness to the immediate family and not to the patient, in case it may cause distress and loss of hope in the patient. The unfortunate consequences of not revealing a life-threatening diagnosis, such as incurable cancer, to the patient is that he or she may lose the opportunity of attending to financial matters [eg. division of assets], taking leave of loved-ones, or engaging in spiritual activity.

* Confidentiality

The medical practitioner is obliged to maintain confidentiality by not disclosing medical information to another party without the authorisation of the patient. But such authorisation is implied when a medical practitioner works in liaison with another health professional where sharing of information is paramount. Also, in exceptional circumstances where the patient’s illness may place others at risk [eg. in epidemics of infectious disease; major psychiatric illness [in situations where the patient poses a danger to self or others], or if the information is legally requested, the principle of patient confidentiality may be overridden.

JUSTICE

Based on the principle of fairness, justice, in relation to healthcare refers to the equitable distribution of medical resources, e. g. hospital facilities, medical personnel, laboratory tests, medications, etc., known as ‘distributive justice’. When healthcare operates with limited resources, distribution of resources may have to be made according to need.

CONFLICTS BETWEEN ETHICAL PRINCIPLES AND THEIR RESOLUTION

The modern-day medical practitioner is expected to be guided by the above ethical principles rooted in common morality, and hence universally applicable. But not uncommonly, the practitioner is faced with having to determine the best course of action when ethical principles collide – commonly between beneficence and autonomy.

Albert R Jonsen, a pioneer in bioethics, proposed a practical approach to resolving ethical conflicts in clinical practice. His model involves balancing considerations of competing issues [‘kinetics of the case’], in order to choose the preferred course. He proposes the following core issues [which constitute the ‘morphology of the case’] in organising the clinician’s thinking in decision-making:

* Medical indications: A formulation of the case with proposed treatment options and goals of care, including potential risks and benefits of treatment.

* Patient preference: A guiding principle in autonomous patients. In non-autonomous patients, taking into account their prior preferences [if known] / advance directive / surrogate decision.

* Quality of life: Refers to the expected outcome [both positive and negative] of clinical intervention in terms of physical and psychological well-being experienced by the patient, eg. experience of pain, degree of mobility, social interaction, mental acuity etc. This Concept becomes particularly relevant in end-of-life cases and termination of life support.

* Contextual features: These are factors external to the doctor-patient relationship and the clinical assessment of the case but may have an impact on patient care. They include family, religious, financial and legal matters etc. that may conflict with the ethical task.

CONCLUSION

The above is an overview of ethical principles founded on morality, integrated into clinical practice. A recognised model of case analysis in resolving potential conflicts between ethical principles is presented. It must be stressed that an essential footing in upholding ethical conduct in medicine is empathic communication, which involves active listening and exercising a deep level of understanding and care by the medical practitioner. Good record keeping by the medical practitioner will always stand in good stead, not only for the patient but also for the practitioner.

References

Jonsen, Albert R: Clinical Ethics. A Practical Approach to Ethical Decisions in Clinical Medicine. McGraw Hill Education -Lange, 9^th. Ed.

Beauchamp, Tom L; Childress, James F: The Principles of Biomedical Ethics. Oxford University Press, 8^th. Ed.

[Dr. Galhenage MBBS; DPM; MRCPsych; FRANZCP is a retired psychiatrist, and a former examiner to the Royal Australian and New Zealand College of Psychiatrists]

by Dr. Siri Galhenage

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Features

Complexities in global politics deepen as economic pressures intensify

Published

3 hours ago

2026/08/27

Sahan Weerasooriya

UK Prime Minister Andy Burnham meets Ukrainian President Volodymyr Zelensky in Kyiv. (BBC)

The present offer by the UK to strengthen Ukraine’s defense capabilities in the missile technology field in particular comes as ‘a stitch in time’ and the initiative is also likely to be appreciated considerably by democratic opinion world wide for the possible morale-boosting effect it would have on Ukraine. Besides continuous arms support, the conviction that the world’s frontline democracies are behind it would prove a huge plus in Ukraine’s eyes in its grinding fightback against the Russian invasion.

While continued US support for Ukraine could not be considered ‘a given’ any more, British Prime Minister Andy Burnham’s words during a recent visit to Kyiv that the UK would stand by Ukraine ‘for as long as it takes’ is the kind of assurance that Ukraine needs at present. For, the conflict in Ukraine is essentially a war of liberation conducted by the latter against an invader and deeply at issue here is the upholding of International Law and its foundational concepts, such as national sovereignty and a nation’s right to political self-determination. The world of democracy is of the firm view that the latter ideals cannot be compromised, come what may.

The UK has its work cut out in this connection. It would find it difficult to convince the Trump administration that it should staunchly stand by Ukraine but it could campaign vigorously with the rest of the West and the EU fold in particular to unflaggingly support the embattled and over-run country.

Ukraine has shown an impressive adeptness in using drone technology in particular against her enemy and has even manufactured her own hardware in this respect but using the relevant blueprints handed over by the UK for the manufacture of more sophisticated cruise missiles, for instance, may prove financially difficult, going forward. It is left to be seen whether the UK and the rest of the West who are with Ukraine will continue to be with her, considering their own rising financial constraints.

The latter impediments could only multiply in the future. Oil, gas and energy prices are on the rise and the latter costs are glaringly reflected in kitchens and meal tables the world over. As we go along consumer discontent would steadily intensify and governments, East and West, would need to figure out with considerable rigour and foresight how such disaffection could be ably managed. Failing which, in most democratic societies, the chances are that publics would be out on the streets demanding that their grievances be redressed forthwith.

These rising concerns are reflected in a recent move by some EU governments to consider imposing what is described as ‘a windfall tax’ on the profits specified major oil companies operating within their shores have made in the wake of the US-Israel war on Iran. The rationale apparently is to use such tax earnings to cushion the rising cost of living of their publics and bolster the respective countries’ social expenditure.

In a recent letter to the president of the EU Council the EU governments referred to said, among other things, while drawing attention to the ‘discontent that is growing over the rising cost of living’: ‘A common approach’ is needed that ‘ensures those who profit from the crisis contribute their share to reducing the burden on the general population.’ Meanwhile, Oxfam with reference to the above development is on record as calling for a ‘permanent windfall tax of at least 50% on profits exceeding a 10% return on investment.’

Such are the rising economic pressures on the majority of Western governments. The question to be posed is how consistent they would be in their assistance to Ukraine if they decide consensually to stand by her. The soaring cost of living in the West compels the conclusion that there could be no guarantee that Western assistance to Ukraine, particularly in the defense and security fields, would be of a longstanding kind.

Of particular concern would be the fact that the weapons systems on offer from the UK to Ukraine could be increasingly costly to manufacture going forward. Besides they would need to be manufactured and put into action without delay.

However, these considerations should in no way deflect Ukraine’s supporters from the principled policy stance of defending her to the extent possible. Because at issue is the defense of International Law and the democratic system of government from their enemies; fascism and authoritarian rule.

While during World Wars 1 and 2 the US was with the major democracies of the West, this time around with regard to Ukraine, the US has chosen to be at cross-purposes with them. For instance, in relation to tariff matters and defense expenditure, in the NATO context, the US is pursuing a hard line which puts it at polar opposites with the West. Thus it is no longer possible to talk unreservedly of a ‘Western democratic alliance’. Put plainly, the cause of democratic development has been weakened.

A measure of relief for the supporters of Ukraine in the West could come by way of the upcoming mid-term polls in the US. If the Democratic Party fares well in them the pressure would be on the Trump administration to defer to opposition opinion at home, accommodate the best interests of Ukraine in its West European policy and perhaps even work towards a diplomatic solution to the Ukraine crisis in cooperation with Russia. Accordingly, the Democratic Party would need to put the Trump administration on the defensive, so to speak.

Until such time Ukraine’s Western supporters have no choice but to remain committed to it, ensure its steadfast defense against the invasion and work judiciously towards keeping the economic pressures at home in check.

Interestingly, at the present juncture in international politics the US could be said to be more weak than strong. For example, it has to some extent been militarily humbled by Iran; so much so it is resorting to economic means to keep Iran in check.

In keeping with this strategy, the US has launched ‘a new big wave of anti-Iran economic sanctions’ at the time of writing, aimed at cutting Iran away from all its major income sources. Some of these relate to digital assets, technology, gold, aviation and shipping. The hoped for result is the complete severance of Iran from the US dollar system.

However, while the UK and EU have no choice but to adhere to their policy of backing Ukraine, going forward they would need to dialogue more closely with the US and ensure that it cooperates with them on outstanding questions, such as Ukraine and the strengthening of democracy. The well being of the world is served when the latter aim is pursued.

Features

“Envisioning Sri Lanka: Beyond Recovery”

Published

3 hours ago

2026/08/27

Sahan Weerasooriya

Prime Minister Dr. Harini Amarasuriya opening the event

OPA 39th Annual Conference calls for Sri Lanka to move Beyond Recovery towards Sustainable Transformation

The Orgnisation of Professional Associations (OPA) successfully concluded its 39th Annual Conference, held recently at the Cinnamon Grand Colombo, under the theme “Envisioning Sri Lanka: Beyond Recovery”.

Held under the patronage of Jayantha Gallehewa, President of the OPA, with the leadership and guidance of Tisara De Silva, President-Elect and Chairman of the 39th Annual Conference, the Conference brought together leading professionals, academics, business leaders and representatives of the public and private sectors to deliberate on Sri Lanka’s next phase of national development.

The Inaugural Session, on August 2026, was graced by Prime Minister Dr. Harini Amarasuriya, as the Chief Guest; Andrew Patrick, British High Commissioner to Sri Lanka, as the Guest of Honour; and Murtaza Jafferjee, Chairman of the Advocata Institute, Sri Lanka, as the Keynote Speaker.

In her address, Prime Minister Dr. Harini Amarasuriya emphasised that overcoming the economic crisis alone should not be Sri Lanka’s ultimate objective, stressing that recovery must serve as the foundation for a broader economic and institutional transformation necessary for sustainable national progress. Reflecting on the difficult period experienced by the country, the Prime Minister noted that Sri Lanka had faced significant economic, social and institutional challenges, which had weakened public confidence and created uncertainty about the country’s future.

She stressed that “recovery only provides the foundation” and that Sri Lanka can move forward sustainably only by using that foundation to bring about meaningful transformation.

The Prime Minister observed that the theme of the OPA’s 39th Annual Conference, “Envisioning Sri Lanka: Beyond Recovery,” aptly encapsulated these national aspirations. She emphasised that Sri Lanka’s objective should not merely be to return to the conditions that existed before the crisis, but to forge a stronger national foundation characterised by robust institutions, a resilient economy, high-quality public services and an enabling environment in which every citizen has the opportunity to thrive.

She further underscored that Sri Lanka’s future development cannot be secured through economic growth and physical development alone. She emphasised that the effective mobilisation of the country’s knowledge, skills and professional expertise, is equally essential to achieving sustainable and inclusive national progress

The Technical Sessions held on 12 August 2026 brought together 19 distinguished experts and professionals representing academia, industry, banking and finance, public health, technology, management and business leadership. Their diverse expertise provided a multidisciplinary platform to examine the critical challenges, emerging opportunities and strategic choices that will shape Sri Lanka’s next phase of development, with particular emphasis on economic transformation, institutional strengthening, digitalisation, private-sector growth, human capital and sustainable development.

The deliberations were structured around four principal sub-themes: “Resilient Recovery and Sustainable Economic Development”; “Future Readiness: Innovation & Transformation”; “Policy for Impact: Advancing Equity, Sustainable Living, and National Well-Being”; and “Leadership, Governance and National Responsibility.”

Across these thematic areas, the sessions explored the structural reforms, institutional requirements and policy choices necessary to move Sri Lanka beyond economic stabilisation towards a more productive, competitive, resilient and inclusive economy. The discussions brought together diverse professional perspectives, enabling participants to examine national priorities through economic, technological, industrial, financial, social and governance lenses.

Particular emphasis was placed on the need to move beyond the diagnosis of problems towards pragmatic, evidence-based and implementable solutions. The deliberations recognised that sustainable national progress requires not only sound policies, but also effective institutions, professional competence, innovation, responsible leadership and the capacity to translate policy into tangible outcomes.

The sessions further underscored the importance of collaboration across sectors, recognising that Sri Lanka’s complex development challenges cannot be addressed in isolation. Stronger engagement among Government, private sector, professional associations, academia and civil society was identified as essential to fostering a coherent national response and ensuring that professional knowledge and expertise are effectively translated into policy and action.

Collectively, the Technical Sessions provided a substantive platform for knowledge exchange, critical reflection and forward-looking dialogue, reinforcing the OPA’s commitment to bringing the country’s professional expertise to bear on the task of building a resilient, innovative, equitable and prosperous Sri Lanka.

The OPA expressed its sincere appreciation to Prime Minister Dr. Harini Amarasuriya, the Chief Guest; Andrew Patrick, British High Commissioner to Sri Lanka and Guest of Honour; and Murtaza Jafferjee, Chairman of the Advocata Institute, Sri Lanka and Keynote Speaker, for their distinguished contributions to the Conference.

Much of what the 39th Annual Conference achieved would not have been possible without the leadership, commitment and generous contributions of Jayantha Gallehewa, President of the OPA; Tisara De Silva, President-Elect and Chairman of the 39th Annual Conference; Eng. Ravi Rupasinghe, General Secretary; Dharshana Wijemanne, Treasurer; Bhanu Wijayaratne, Convener & the Chairman of the Session Planning Committee of the 39th Annual Conference Committee, Past Presidents and Office Bearers; Presidents and representatives of Member Associations; members of the Executive Councils and General Forum; and the distinguished Session Chairmen, Resource Persons and professionals who shared their time, expertise and insights in pursuit of the Conference’s shared vision. The OPA remains immensely grateful to all those whose collective contributions enriched the 39th Annual Conference and strengthened its role as a meaningful platform for professional exchange, informed dialogue and national reflection.

Features

Nostalgia for Lankans in Toronto …

Published

4 hours ago

2026/08/27

Sahan Weerasooriya

‘Avurudu Musical Show 2027,’ a uniquely styled musical Avurudu celebration … Ceymphony Band style.

For Sri Lankans living 14,000 kilometres from home, the sound of home has never felt closer — and that’s thanks to one man and his band.

Since stepping into the spotlight, Gamini Hemalal and the Ceymphony Band have turned into the heartbeat of the Sri Lankan community in Toronto.

Their mission is simple: bring the music, bring the memories, bring the people together. And it’s working.

What turned out to be the talk-of-the-town was their intimate musical evening with Sri Lanka’s legendary crooner Sohan Weerasinghe.

Sohan Weerasinghe: Had
everyone on their feet at the
Angus Glen Golf Club, in
Toronto, Canada

It was a ‘full house’ long before the big date. Tickets vanished within days — demand was that overwhelming.

According to those who were there, it was a truly amazing evening. The hall was packed, the energy electric. Sohan didn’t just sing — he owned the stage.

With his velvet vocals, his charm, and that signature style, he had everyone on their feet. The ladies, especially, couldn’t get enough. No wonder they call him “The Ladies’ Man!”

One attendee summed it up perfectly:

“We had so much fun. It is truly a blessing to have our kids around us, enjoying these beautiful moments together. Thank you, Gamini Hemalal, for such a wonderful evening, with an amazing crowd and an incredible atmosphere. Your hard work and dedication truly made it a special night.

“We also need to say a big thank you to the Ceymphony Band for delivering such an outstanding performance. You all were absolutely amazing! Our entire family had a fantastic time, and we truly enjoyed every moment.

Ceymphony Band: Extremely popular in the scene in Toronto

“Wishing you all continued success. Keep up the amazing work, we can’t wait for the next.”

And the next is already on the cards: ‘Halloween Pissu Baila Party 2026,’ on Friday, 30th October, at the famous Angus Glen Golf Club.

Gamini promises a crazy night of baila, music, dancing and Halloween vibes with the Ceymphony Band. Action runs from 8:00 PM to 12:00 midnight, with plenty of prizes to be won.

Gamini Hemalal: Amazing work for the Sri Lankan community,
in Toronto, Canada

Gamini is also putting together a special event, connected with the 2027 Avurudu celebrations — ‘Avurudu Musical Show 2027,’ a uniquely styled musical Avurudu celebration … Ceymphony Band style.

It’s scheduled to be held on Saturday, 10th April, 2027, also at the Angus Glen Golf Club.

Through music, Gamini Hemalal and Ceymphony are doing what diaspora bands do best — they’re shrinking the distance between two worlds.

One baila beat at a time, one full house at a time, they’re making sure that even in Canada, Sri Lankans feel like home.

Yes, there is plenty of action, indeed, for the Sri Lankan community in Toronto, Canada.